Bipolar androgen therapy (BAT) in metastatic castration-resistant prostate cancer (mCRPC) patients drives testosterone levels above the physiologic range and then back to near-castrate levels during the 28-day treatment cycle. 

Prior treatment with BAT in patients receiving immune checkpoint inhibitors is associated with a more durable therapeutic response, indicating that BAT primes mCRPC patients to respond to immune checkpoint inhibitors. To test this hypothesis, the prospective phase 2 COMBAT study was conducted. The findings are published in the journal Nature Communications.

Baseline Characteristics

The study enrolled a total of 45 patients, with the majority having a Gleason score of ≥ 9. Nearly half (44.4%) of the patients had received taxane chemotherapy previously. All the patients had received a minimum of one dose of BAT. The median age of the participants was 69 (51–86) years.

Bipolar Androgen Therapy and Prostate-Specific Antigen Response

A prostate-specific antigen decrease of > 50% from baseline (PSA₅₀) of 40% was achieved. The PSA₅₀ response rate with BAT monotherapy was 35.6%.  

Prostate-Specific Antigen Response and Nivolumab

The majority of the PSA₅₀ responses were recorded on BAT monotherapy; however, two PSA₅₀ responses and three objective responses were associated with the addition of nivolumab to the BAT treatment regimen. Genomic alterations were not associated with rates of PSA₅₀ responses.

Patient Survival Outcomes

The median radiographic progression-free survival (rPFS) was 5.6 (5.4–6.8) months. The median overall survival (OS) in the patients was 24.4 (17.6–31.1) months. After being stratified by prior chemotherapy and androgen receptor-targeted therapies, there were no significant differences in rPFS and OS rates. Poor clinical outcomes were observed in patients with high Gleason scores and visceral disease.

Safety Outcomes in Bipolar Androgen Therapy With Nivolumab

The majority of the adverse outcomes that occurred in patients receiving BAT with or without nivolumab were grade 2 or less. BAT monotherapy was associated with grade 3 musculoskeletal pain in one patient and lower extremity edema in another patient.  

Bipolar Androgen Therapy and Biopsy-Based Clinical Response

In pre-treatment biopsies of mCRPC patients, the median density of CD8+ T cells and the PD-1+ subset was higher in BAT ± nivolumab treatment responders compared to non-responders. Similar trends were observed in CD4+ T cells and the PD-1+ subset of CD4+ cells.

Source:

Markowski, M. C., Taplin, M., Aggarwal, R., Sena, L. A., Wang, H., Qi, H., Lalji, A., Sinibaldi, V. J., Carducci, M. A., Paller, C. J., Marshall, C. H., Eisenberger, M. A., Sanin, D. E., Yegnasubramanian, S., Gomes‐Alexandre, C., Ozbek, B., Jones, T., De Marzo, A. M., Denmeade, S. R., & Antonarakis, E. S. (2024). Bipolar androgen therapy plus nivolumab for patients with metastatic castration-resistant prostate cancer: the COMBAT phase II trial. Nature Communications, 15(1). https://doi.org/10.1038/s41467-023-44514-2 

Prostate cancer affects a substantial proportion of men across the globe, with more than 80% of the patients being diagnosed with localized prostate cancer, which corresponds to tumor (T) stage of T2c or below. There is a lack of definite guidelines for treatment modalities in localized prostate cancer. 

A randomized controlled trial aimed to formulate a nomogram for predicting the risk factors of overall survival (OS) and cancer-specific survival (CSS) in elderly individuals with localized prostate cancer based on surgery- and radiotherapy-based survival differences. The findings are published in the journal BioMed Central Urology.

Baseline Characteristics

The study enrolled 90,434 patients, with 63,328 and 27,106 patients in the training and validation cohorts, respectively. The mean age of the patients was 71.4 ± 5.29 years, and the majority of patients were White (78.3%). Of the total patients, 18.97% had grade I, 44.73% had grade II, 36.27% had grade III, and 0.03% had grade IV tumors. There were no statistically significant differences in the baseline features of the two groups.

Prognostic Factors in Localized Prostate Cancer

Based on the COX regression analysis, the factors related to patient outcomes were age, T stage, surgery, chemotherapy, radiotherapy, biopsy Gleason Score, prostate-specific antigen (PSA), age, race, tumor grade, and marriage. Independent risk factors affecting CSS were Gleason score, age, race, marriage, surgery, PSA, T stage, and radiotherapy, whereas those associated with OS outcomes were age, race, Gleason score, PSA, marriage, surgery, and radiotherapy.

Nomogram Construction and Survival Prediction

Internal cross-validation, calibration curve, area under curve, and external temporal validation values indicated that the discriminability strength of the nomogram was high, based on predicting the CSS and OS patient outcomes.

Clinical Application of Prediction Model

The OS and CSS nomograms demonstrated the best clinical potential for predicting localized prostate cancer. The OS and CSS rates were found to be relatively higher in patients in the low-risk group compared to high-risk group patients in training and validation cohorts. The lowest OS and CSS rates were observed in high-risk patients who did not undergo radiotherapy but received local irradiation.    

Source:

Zhanghuang, C., Zhu, J., Li, Y., Wang, J., Ma, J., Li, L., Yao, Z., Ji, F., Wu, C., Tang, H., Xie, Y., Yan, B., & Yang, Z. (2024). Prognostic significance of surgery and radiotherapy in elderly patients with localized prostate cancer: establishing and time-based external validation a nomogram from SEER-based study. BMC Urology, 24(1). https://doi.org/10.1186/s12894-023-01384-6 

Prostate cancer patients are prone to adverse metabolic changes that stem from the physical effects of androgen deprivation therapy (ADT). These changes include body fat accumulation and abnormal fasting glucose levels, with subsequent development of metabolic syndrome. 

In this randomized interventional study, the authors aimed to assess the clinical effectiveness of a nurse-led mobile-based health education program in promoting a healthy lifestyle in prostate cancer patients on ADT. The study findings are published in the Journal of Medical Internet Research mHealth and uHealth.

Baseline Characteristics

The study included 22 participants in the control group and 22 participants in the experimental group. The mean age and monthly income of study participants was 68.83 ± 7.09 years and $3679.77 ± 4603.72, respectively. The majority of the participants were ex-smokers and the mean smoking duration was 16.13 ± 21.38 years. The most common comorbidities in the participants were cardiovascular diseases. Approximately 65% of the participants received ADT with an average duration of 40.63 ± 24.71 months. The mean Gleason score and levels of prostate-specific antigen (PSA) was 7.80 ± 0.98 and 0.07 ± 0.19 ng/ml.

Health Coaching Program and Lifestyle Scores

The baseline lifestyle scores were not significantly different between the control and experimental groups. The scores increased consistently in the experimental group; however, no consistent improvement was observed in the control group. These differences in the lifestyle scores were statistically significant (p ≤ 0.001).

Health Coaching Program and Metabolic Syndrome Components

There were no significant differences in the prevalence of metabolic syndrome parameters, including systolic and diastolic blood presure, fasting blood sugar, HDL cholesterol, and triglyceride levels, between experimental and control groups before and after the health coaching program. However, in the experimental group, the body mass index and body weight decreased significantly after the health coaching intervention. This decline was greater in the experimental group compared to the control group.

Healthy Related Quality of Life 

Compared to the control group, the experimental group participants reported a significant improvement in urinary obstructive and irritative domains of health-related quality of life.

Source:

Lee, K., Park, J., Oh, E. G., Lee, J. H., Park, C. G., & Choi, Y. D. (2024). Effectiveness of a Nurse-Led Mobile-Based health coaching program for patients with prostate cancer at high risk of metabolic syndrome: randomized waitlist controlled trial. Jmir Mhealth and Uhealth, 12, e47102. https://doi.org/10.2196/47102 

Bone metastasis is a common consequence of disease progression in primary prostate cancer patients and plays an important role in the morbidity and mortality outcomes in patients diagnosed with advanced prostate cancer. However, the clinical identification of bone metastasis is challenging. 

In the current study, the authors aimed to integrate deep learning algorithm-based proteomics and radiomics into a model for prediction of bone metastasis in participants with primary prostate cancer. The details of the prediction model and the feasibility of early diagnosis are published in the Journal of Cancer Research and Clinical Oncology.

Baseline Characteristics

A total of 211 patients were included in this study, with 106 and 105 patients classified into the bone metastases and non-bone metastases groups, respectively. The training and validation groups included 169 and 42 patients, respectively. The median age of training group participants was 73 (66–78) years and that of validation group participants was 74 (67–78.25) years. There were no significant differences in the bone metastases incidence between validation and training groups. Both groups were comparable in terms of baseline characteristics.

Selection of Radiomics and Pathomics Features

A total of 2,553 radiomics and 2,048 pathomics features were extracted from the imaging and histopathologic samples, respectively. Based on the LASSO model, 13 pathomics, 44 radiomics, and 23 deep transfer learning (DTL) features with non-zero coefficients were identified. These features were closely related to bone metastases, forming the basis of the prediction models.   

Radiomics and Pathomics Model Validation

The support vector machine (SVM) model was considered the best prediction model for radiomics features, with an area under the curve (AUC) value of 0.86 (0.735–0.979). The logistic regression (LR) model utilizing DTL was found to have the best predictive performance, whereas the Naïve Bayes model had the highest predictive capability for pathomics features. The AUC for the LR model was 0.89 (0.799–0.989) and the AUC for the Naïve Bayes model was 0.85 (0.714–0.989). The most effective predictive model, which combined DTL features, radiomics features, and pathomics features using the SVM model, yielded an AUC value of 0.93 (0.854–1.000).

Clinical Use of Predictive Model

Compared to the clinical models, the radiomics and pathomics models had better diagnostic performance in predicting bone metastases in primary prostate cancer. The decision curve analysis demonstrated net clinical benefit for the model based on combined features and DTL features.     

Source:

Zhang, Y. F., Zhou, C., Guo, S., Wang, C., Yang, J., Yang, Z. J., Wang, R., Zhang, X., & Zhou, F. H. (2024). Deep learning algorithm-based multimodal MRI radiomics and pathomics data improve prediction of bone metastases in primary prostate cancer. Journal of cancer research and clinical oncology, 150(2), 78. https://doi.org/10.1007/s00432-023-05574-5

Prostate cancer screening with prostate-specific antigen (PSA) plays a pivotal role in decreasing cancer-related mortality. Screening with PSA testing and tissue biopsies prompts overdiagnosis of cancer. While guidelines recommend repeat testing every 1 to 4 years, there is limited data to support the use of magnetic resonance imaging (MRI) in repeat cancer screening. 

In a secondary analysis of the STHLM3-MRI trial, a prospective, randomized population-based study, the authors assessed the outcomes of PSA testing with MRI and biopsies in repeated prostate cancer screening. The study’s findings are published in JAMA Network Open.

Baseline Characteristics

A total of 1,500 participants were eligible for the clinical trial. The median age of the participants was 67 (61–72) years. The median PSA levels at baseline were 2.8 (2.1–4.0) ng/mL, and previous biopsies had been performed in approximately 16.3% of the patients. Approximately 20.2% of the participants had a positive family history of prostate cancer.

Prostate-Specific Antigen Levels

Of the total participants, 667 had PSA levels ≥ 3 ng/mL. In the re-screening period, 326 of the 1094 men who previously had PSA levels of 1.5–2.9 ng/mL were found to have PSA levels ≥ 3 ng/mL. During re-screening, 119/1094 had PSA levels < 1.5 ng/mL. Of the 406 participants who had PSA levels ≥ 3 ng/mL without cancer detection at the first screening, 341 had PSA levels ≥ 3 ng/mL at the time of re-screening.

Magnetic Resonance Imaging

Approximately 92.5% of the men with PSA levels ≥ 3 ng/mL at the time of the second screening underwent MRI evaluation. Only 4.9% of these patients had a minimum of one suspicious lesion identified on MRI with a Prostate Imaging–Reporting and Data Systems (PI-RADS) score of 4–5, and only 1.5% of men had lesions corresponding to PI-RADS score of 4 or 5. 

Rates of Cancer Detection

Of the 84 men with lesions corresponding to a PI-RADS score ≥ 3, 81 underwent biopsy, of whom 48 were diagnosed with prostate cancer (Gleason score ≥ 7). The PSA levels in 38 out of 48 men were 3–4.9 ng/mL.  

Source:

Nordström, T., Annerstedt, M., Glaessgen, A., Carlsson, S., Clements, M., Abbadi, A., Grönberg, H., Jäderling, F., Eklund, M., & Discacciati, A. (2024). Repeated prostate cancer screening using Prostate-Specific antigen testing and magnetic resonance imaging. JAMA Network Open, 7(2), e2354577. https://doi.org/10.1001/jamanetworkopen.2023.54577 

Metastatic castration-resistant prostate cancer (mCRPC) has a poor prognosis and limited overall survival rates. The standard treatment for mCRPC patients comprises novel hormonal medications and taxanes. Adenosine 2A receptor (A_2AR) inhibition serves as an adjunct to immune-targeting therapies. One such A_2AR antagonist is AZD4635. 

In this phase 2 study, the authors assessed the activity of AZD4635 combined with oleclumab or durvalumab in patients with mCRPC. The study’s findings are published in the journal Cancer Immunology, Immunotherapy.

Baseline Characteristics

The study enrolled a total of 59 patients, of whom 30 received AZD4635 with oleclumab and 29 received AZD4635 with durvalumab. The median age of the participants was 72 (53–90) years, and the majority of participants were heavily pretreated. Approximately 41% of the participants have more than two sites of metastasis.

Disease Progression

The mean treatment duration was 3.05 (0.3–1.44) months for AZD4635 with durvalumab (Module 1) and 3.22 (0.2–15.2) months for AZD4635 with oleclumab (Module 2). In Module 1,  objective response was observed in one patient, seven patients had stable disease for a minimum of 35 days, ten patients had disease progression, and one patient died. In Module 2, eight patients had stable disease for a minimum of 35 days, 11 patients had disease progression, and one patient died. The remaining patients in both cohorts had Response Evaluation Criteria in Solid Tumors (RECIST) progression.

Prostate Specific Antigen Response

Two patients in Module 1 and three patients in Module 2 had a prostate-specific antigen (PSA) response to AZD4635 treatment. Only one patient from each Module 1 and Module 2 experienced a confirmed treatment response.

Patient Survival

The median radiological progression-free survival (rPFS) in Module 1 and Module 2 was 2.3 (1.6–3.8) and 1.5 (1.3–4.0) months, respectively. The median overall survival in Module 1 was 10.7 (7.2–NE) months. There were no differences  in progression-free survival between participants with high or low levels of peripheral adenosine signaling.

Safety Profile

The most frequent adverse events associated with AZD4635 were nausea, fatigue, and reduced appetite in Module 1 and nausea, fatigue, and vomiting in Module 2. Three and two patients in Module 1 and Module 2, respectively, experienced a minimum of one grade ≥ 3 adverse event. In Module 1 and Module 2, 11/12 and 9/11 deaths were attributed to the disease under investigation, respectively.

Source:

Falchook, G. S., Reeves, J. A., Gandhi, S., Spigel, D. R., Arrowsmith, E., George, D. J., Karlix, J. L., Pouliot, G. P., Hattersley, M. M., Gangl, E., James, G., Thompson, J., Russell, D. L., Patel, B., Kumar, R., & Lim, E. A. (2024). A phase 2 study of AZD4635 in combination with durvalumab or oleclumab in patients with metastatic castration-resistant prostate cancer. Cancer Immunology, Immunotherapy, 73(4). https://doi.org/10.1007/s00262-024-03640-6 

Herbal supplements containing plant sterols, vitamins, and minerals are widely used to enhance prostate health. Beta-sitosterol often forms the most abundant component of these supplements. 

A study in the American Journal of Clinical and Experimental Urology reviewed the available evidence regarding the efficacy, safety, and mechanisms of action of beta-sitosterol for treating prostate cancer (PCa) and benign prostatic hyperplasia (BPH).

Promotes Apoptosis of Pca Cells

Initial research on beta-sitosterol focused on in vitro cultured PCa cells. Awad et al. found that beta-sitosterol reduced invasiveness, motility, and laminin–fibronectin binding in PC-3 cells and diminished tumor growth and metastases in mice. They concluded that beta-sitosterol may inhibit tumor growth by inducing apoptosis and cell cycle arrest through alterations in reactive oxygen species and prostaglandin production. Multiple other studies corroborated these findings in various PCa cell lines. 

Other mechanisms highlighted were decreased anti-apoptotic proteins, increased pro-apoptotic proteins, inhibition of migration and proliferation of cancer cells, and altered membrane composition. Findings from recent in vivo studies are consistent with the previous conclusions that beta-sitosterol may induce PCa cell apoptosis. Beta-sitosterol may also exert anti-tumorigenic effects by interacting with specific proteins and influencing gene expression and immune responses. However, there is no definitive evidence regarding its therapeutic potential for PCa.

Reduces Prostatic Epithelial Proliferation

Dihydrotestosterone (DHT) binds to androgen receptors (ARs) on epithelial and stromal prostatic cells and regulates gene expression. Disruptions in this process contribute to prostate enlargement. Plant sterols, including beta-sitosterol, chemically resemble DHT and 5α-reductase inhibitors. In vitro studies revealed that saw palmetto extracts inhibited 5α-reductase, the enzyme that converts testosterone to its active DHT form.

Studies in rat models demonstrated beta-sitosterol’s ability to dramatically reduce prostatic hyperplasia, comparable to finasteride. Moreover, these phytosterols may decrease testosterone levels by competing with cholesterol for intestinal absorption. In one study, beta-sitosterol-enriched saw palmetto oil (VISPO) exhibited superior efficacy compared to conventional saw palmetto (SPO) and finasteride in reducing prostate weight, testosterone levels, inducing apoptosis, and reducing inflammation in rat models of testosterone-induced BPH. Beta-sitosterol’s effects are not well documented in the prostatic stromal tissues of rats.

Beta-Sitosterol-Containing Phytosterols Prove Efficacious in BPH Treatment

The first large clinical study, conducted in Germany in 1993, found beta-sitosterol efficacious in treating BPH, significantly improving symptoms and urinary flow parameters. Another study by Marks et al. tested a saw palmetto herbal blend and noted no change in prostate volume but observed epithelial contraction in the transition zone and increased atrophic glands, akin to finasteride’s effects. 

Additionally, the PERMAL study, a large trial evaluating the efficacy of Permixon (extract of Serenoa repens) concluded that Permixon was slightly superior to tamsulosin in reducing lower urinary tract symptoms (LUTS) in severe BPH. Other studies found similar efficacy of Serenoa repens extract and tamsulosin in treating BPH but no added benefits with combined therapy. 

On the contrary, the first large American study found no substantial difference between saw palmetto and placebo in improving symptoms or objective measures of BPH. However, a subsequent study indicated significantly reduced symptoms with VISPO versus placebo or SPO. The TRIUMPH study, a large European trial, found that phytosterols, although improving symptoms significantly, were less effective than alpha-blockers and 5α-reductase inhibitors.

A meta-analysis of various publications came to the conclusion that Serenoa repens extracts showed some efficacy in alleviating LUTS, at least after 1 year of use, and might be appropriate for patients who want to avoid alpha-blockers and do not require rapid symptom relief. No adverse events or toxicities have been documented with these supplements. Collectively, these data have led investigators to conclude that beta-sitosterol supplements might be most appropriate for younger men with minimal symptoms who do not want to take clinical drugs for BPH.

Source:

Macoska J. A. (2023). The use of beta-sitosterol for the treatment of prostate cancer and benign prostatic hyperplasia. American journal of clinical and experimental urology, 11(6), 467–480. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10749388/

Many prostate cancer (PCa) patients experience biochemical recurrence (BCR) during treatment. Early BCR detection is essential for timely intervention to limit disease progression and improve survival. Radiomics is a method based on extracting quantitative features from radiology images and using the data to make a clinical decision support system. 

A study in the Journal of Applied Clinical Medical Physics aimed to develop radiomics models based on automatic segmentation of pretreatment MRI apparent diffusion coefficient (ADC) maps to predict advanced PCa BCR after radiotherapy, hormonal therapy, or other systemic therapy.

Patient Characteristics

A total of 100 patients were enrolled and randomly assigned to training (n=70) and testing (n=30) groups for the models. Of these, 35 were BCR-positive (n=25 in the training cohort, n=10 in the test cohort). No significant differences were observed in the age and clinical characteristics between the training and test datasets.

Development of the Radiomics Models 

Features were extracted from automatically segmented regions of interest on the ADC maps. Four predictive models were constructed and tested. Two predictive models were designed by combining age, serum prostate-specific antigen level, Gleason score, and pretreatment clinical staging with the prostate area (Model_1) or PCa area (Model_2). The other two predictive models were constructed based only on the automatic prostate area (Model_3) and automatic PCa area (Model_4).

Performance Evaluation of the Models

All the models were found to perform well, with relatively good accuracy, in predicting the BCR of advanced PCa from pretreatment ADC maps. The area under the curve (AUC) values were 0.770 (95% confidence interval (CI): 0.527–1.000), 0.793 (95% CI: 0.604–0.981), 0.840 (95% CI: 0.698–0.983), and 0.808 (95% CI: 0.627–0.988) for Model_1, Model_2, Model_3, and Model_4, respectively, in the test datasets. The radiomics-only models, i.e., Model_3 and Model_4, demonstrated slightly better performance in predicting advanced PCa BCR than the radiomics models combined with clinical characteristics, i.e., Model_1 and Model_2. 

The predictive models based on the prostate area (Model_1 and Model_3) showed equivalent performance to those based on the PCa area (Model_2 and Model_4). The DeLong test demonstrated that there was no significant difference between each model (all p>0.05). Moreover, the 95% bootstrap confidence interval for the precision-recall area difference included 0 between each model (all p>0.05).

Hence, the radiomics models developed in the study were predictive of advanced PCa BCR. Their predictive information may aid in the selection of appropriate, individualized treatment.

Source:

Wang, H., Wang, K., Ma, S., Gao, G., & Wang, X. (2023). Investigation of radiomics models for predicting biochemical recurrence of advanced prostate cancer on pretreatment MR ADC maps based on automatic image segmentation. Journal of Applied Clinical Medical Physics. https://doi.org/10.1002/acm2.14244 

Positive surgical margins (PSMs) represent an adverse feature in prostate cancer patients undergoing radical prostatectomy (RP). PSMs are common post-RP and found in 6–40% of patients. Although PSMs are strongly associated with the risk of biochemical recurrence (BCR), a correlation has not been definitively established between overall mortality (OM) and cancer-specific (CSM) mortality. 

A study published in the journal European Urology Oncology assessed whether the presence and features of PSMs are associated with BCR, OM, and CSM in prostate cancer patients who underwent robotic-assisted RP (RARP) with a post-op follow-up of ≥10 years.

Patient Characteristics

A total of 8141 patients were enrolled, of whom, 1348 (16%) had PSMs. Among these, 1134 (84%), 166 (12%), and 48 (3.6%) demonstrated PSMs that were <3mm, ≥3mm, and multifocal, respectively. Patients with PSMs had worse pathological and clinical characteristics than those without PSMs.

Significant Association of Multifocal PSMs With CSM and OM

At a median follow-up of 143 months, 1550 (19%) participants had BCR and 898 (11%) died. Multivariable analyses revealed that the presence and features of PSMs were significantly associated with BCR (all p<0.001). The probabilities of 10-year BCR-free survival were 85% and 70% in men without and with PSMs, respectively.

In contrast, only multifocal PSMs showed a significant association with CSM (hazard ratio (HR): 4.68) and OM (HR: 1.82). The probabilities for 10-year cancer-specific and overall survival, respectively, were 95% vs. 99% and 87% vs. 93–94% for participants with multifocal PMS vs. the others.

Association Between Multifocal PSMs and Mortality

Analyses after stratifying the groups by scores on UCSF’s Cancer of the Prostate Risk Assessment (CAPRA) prognostic tool, groups showed that the presence and features of PSMs were significantly associated with BCR (all p≤0.02) in all groups. The presence of PSMs was associated with CSM in participants in intermediate-risk (HR: 1.71) and high-risk (HR: 2.20) groups. Regarding features of margins, only multifocal PSMs were associated with CSM in participants in intermediate- (HR: 7.26) and high-risk (HR: 9.26) groups and with OM in participants with high-risk cancer (HR: 2.97).

Positive Surgical Margins Impact Prostate Cancer Outcomes

Overall, 3075 (38%) patients had adverse pathological features (pathological stage 3–4, grade group 4–5, lymph node invasion pN1 at final pathology, and/or prostate-specific antigen persistence). The presence and features of PSMs significantly increased the risk of BCR, both in participants with adverse and those with non-adverse pathological features (all p≤0.002). 

In contrast, the presence of PSMs was associated with CSM only in patients with adverse pathological features (HR: 1.79). Moreover, multifocal PSMs were associated with CSM (HR: 9.5) and OM (HR: 2.59) only in those with adverse pathological features. Analyses after excluding 149 patients who received post-RARP adjuvant therapy demonstrated that only multifocal PSMs were associated with both CSM (HR: 5.10) and OM (HR: 1.94).

In conclusion, the study found no association between unifocal PSMs and survival but demonstrated an association between multifocal PSMs and mortality in patients with adverse clinical and pathological characteristics.

Source:

Pellegrino, F., Falagario, U. G., Knipper, S., Martini, A., Akre, O., Egevad, L., Aly, M., Moschovas, M. C., Bravi, C. A., Tran, J., Heiniger, Y., Von Kempis, A., Schaffar, R., Carrieri, G., Briganti, A., Montorsi, F., Rochat, C., Mottrie, A., Ahlering, T. E., . . . Wiklund, P. (2023). Assessing the Impact of Positive Surgical Margins on Mortality in Patients Who Underwent Robotic Radical Prostatectomy: 20 Years’ Report from the EAU Robotic Urology Section Scientific Working Group. European Urology Oncology. https://doi.org/10.1016/j.euo.2023.11.021