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BackgroundThe presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population.MethodsData were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR).ResultsOf the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6%) were up-staged based on the pathologic analysis of PAFP and eight (9.1%) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8-10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7%) nodes were located in the middle portion of the PAFP.ConclusionsThere was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.

As the incidence of prostate cancer (PCa) has increased, screening based on prostate-specific antigen (PSA) has become controversial due to the low specificity of PSA. Therefore, we investigated the diagnostic performance of prostate health index (PHI) density (PHID) for the detection of PCa and clinically significant PCa (csPCa) compared to PSA, PSA density (PSAD), and PHI as a triaging test. We retrospectively reviewed 306 men who underwent prostate biopsy for PSA levels of 2.5 to 10 ng/mL between January 2020 and April 2023. Of all cohorts, 86 (28.1%) and 48 (15.7%) men were diagnosed with PCa and csPCa, respectively. In ROC analysis, the highest AUC was identified for PHID (0.812), followed by PHI (0.791), PSAD (0.650), and PSA (0.571) for PCa. A similar trend was observed for csPCa: PHID (AUC 0.826), PHI (AUC 0.796), PSAD (AUC 0.671), and PSA (0.552). When the biopsy was restricted to men with a PHID ≥ 0.56, 26.5% of unnecessary biopsies could be avoided; however, 9.3% of PCa cases and one csPCa case (2.1%) remained undiagnosed. At approximately 90% sensitivity for csPCa, at the given cut-off values of PHI ≥ 36.4, and PHID ≥ 0.91, 48.7% and 49.3% of unnecessary biopsies could be avoided. In conclusion, PHID had a small advantage over PHI, about 3.6%, for the reduction in unnecessary biopsies for PCa. The PHID and PHI showed almost the same diagnostic performance for csPCa detection. PHID can be used as a triaging test in a clinical setting to pre-select the risk of PCa and csPCa. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the long-term oncological outcomes of robot-assisted radical prostatectomy (RARP) vs. open radical prostatectomy (ORP) in pathologically proven prostate cancer with seminal vesicle invasion (SVI). Methods: We performed a cohort study involving men who underwent radical prostatectomy for prostate cancer with SVI. We adjusted the confounders for RARP versus open surgery using the stabilized inverted probability of treatment weighting. Multivariable survival regression analysis was used to compare the treatment effect of RARP vs. ORP on biochemical recurrence (BCR) and clinical progression (CP). Results: Between January 2000 and December 2012, 272 of 510 men (53.3%) underwent RARP at four tertiary hospitals in Korea. The median follow-up in the entire cohort was 75.7 months (interquartile range, 58.9–96.6 months). Among 389 BCR events, 205 (75.4%) and 184 (77.3%) occurred in the robot-assisted and open groups, respectively. The 5-year BCR-free survival was 22.2% and 20.5% among men who underwent RARP and ORP, respectively (hazard ratio (HR) 0.90; 95% confidence interval (CI), 0.73–1.10; P = 0.29 by the log-rank test). Ninety-nine patients experienced CP (55 and 44 in the RARP and open groups, respectively), representing Kaplan–Meier estimated 5-year event-free rates of 82.1% and 86.1% in the RARP and open groups, respectively, (HR 1.20; 95% CI 0.80–1.79; P = 0.39). Conclusion: The long-term outcomes of RARP for prostate cancer with SVI were comparable to those of open surgery in this large multi-institutional study. However, this result should be confirmed by well-designed prospective randomized controlled trials. [ABSTRACT FROM AUTHOR]

Simple Summary: Multi-parametric magnetic resonance imaging (mpMRI) is regarded as an essential tool for identifying prostate cancer (PCa) in suspected cases. However, unnecessary biopsies continue to be performed in real clinics, especially for prostate imaging reporting and data system version 2 (PI-RADS v2) score-3 lesions, corresponding to the "gray zone". To aid the diagnosis of PCa, as well as of clinically significant PCa (csPCa), in patients with PI-RADSv2 score-3 lesions, we evaluated the clinical utility of the prostate health index (PHI). When a biopsy was restricted to those patients with PI-RADSv2 score-3 lesions and a PHI of ≥30, 34.4% of unnecessary biopsies could be avoided at the cost of missing 8.3% of overall PCa cases. However, there were no cases of missed csPCa diagnosis. The combination of PHI and PI-RADSv2 score-3 lesions offered higher accuracy in the diagnosis of PCa as well as of csPCa. The risk of prostate cancer (PCa) in prostate imaging reporting and data system version 2 (PI-RADSv2) score-3 lesions is equivocal; it is regarded as an intermediate status of presented PCa. In this study, we evaluated the clinical utility of the prostate health index (PHI) for the diagnosis of PCa and clinically significant PCa (csPCa) in patients with PI-RADSv2 score-3 lesions. The study cohort included patients who underwent a transrectal ultrasound (TRUS)-guided, cognitive-targeted biopsy for PI-RADSv2 score-3 lesions between November 2018 and April 2021. Before prostate biopsy, the prostate-specific antigen (PSA) derivatives, such as total PSA (tPSA), [-2] proPSA (p2PSA) and free PSA (fPSA) were determined. The calculation equation of PHI is as follows: [(p2PSA/fPSA) × tPSA ½]. Using a receiver operating characteristic (ROC) curve analysis, the values of PSA derivatives measured by the area under the ROC curve (AUC) were compared. For this study, csPCa was defined as Gleason grade 2 or higher. Of the 392 patients with PI-RADSv2 score-3 lesions, PCa was confirmed in 121 (30.9%) patients, including 59 (15.1%) confirmed to have csPCa. Of all the PSA derivatives, PHI and PSA density (PSAD) showed better performance in predicting overall PCa and csPCa, compared with PSA (all p < 0.05). The AUC of the PHI for predicting overall PCa and csPCa were 0.807 (95% confidence interval (CI): 0.710–0.906, p = 0.001) and 0.819 (95% CI: 0.723–0.922, p < 0.001), respectively. By the threshold of 30, PHI was 91.7% sensitive and 46.1% specific for overall PCa, and was 100% sensitive for csPCa. Using 30 as a threshold for PHI, 34.4% of unnecessary biopsies could have been avoided, at the cost of 8.3% of overall PCa, but would include all csPCa. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this prospective phase II study was to evaluate the efficacy and safety of biweekly docetaxel plus androgen-deprivation therapy (ADT) in patients with metastatic castration-naïve prostate cancer (mCNPC).Patients and Methods: Patients with histologically-proven, previously-untreated mCNPC received ADT plus docetaxel, 40 mg/m2. Docetaxel was repeated every 2 weeks, up to 12 cycles. Endpoints included castration-resistant prostate cancer (CRPC)-free survival, prostate-specific antigen (PSA) response, and safety.Results: A total of 42 patients were registered and analyzed for final outcomes. Of the 42 patients, 36 (86%) completed the 12 planned cycles of docetaxel plus ADT. During a median follow up of 25 months, all but two patients (95%) achieved a PSA response with a nadir PSA level of 0.42 ng/ml (range 0.01-1280.87). The median CRPC-free survival was 26.4 months (95% confidence interval [CI] 20.9-32.0) with a one-year CRPC-free rate of 79% (33 patients, 95% CI 66-91). Multivariable analysis revealed that the performance status of the Eastern Cooperative Oncology Group 0 was independently associated with longer CRPC-free survival (hazard ratio [HR] 0.27, 95% CI 0.07-0.99). The most common adverse events of any grade were anemia (95%), followed by nail changes (33%), fatigue (29%), and oral mucositis (26%). Severe (grade 3 or higher) adverse events were infrequent: pneumonitis (n = 2), diarrhea (n = 1), and neutropenia (n = 1).Conclusion: Our results suggest that biweekly docetaxel plus ADT is feasible, and clinical efficacy does not seem to be compromised compared to a standard triweekly docetaxel 75 mg/m2 plus ADT regimen. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the detection rates of prostate cancer (PCa) and clinically significant PCa (csPCa) using magnetic resonance imaging-targeted biopsy (MRI-TBx) in men with low prostate-specific antigen (PSA) levels (2.5–4.0 ng/mL). Clinicopathologic data of 5502 men with PSA levels of 2.5–10.0 ng/mL who underwent transrectal ultrasound-guided biopsy (TRUS-Bx) or MRI-TBx were reviewed. Participants were divided into four groups: LP-T [low PSA (2.5–4.0 ng/mL) and TRUS-Bx, n = 2018], LP-M (low PSA and MRI-TBx, n = 186), HP-T [high PSA (4.0–10.0 ng/mL) and TRUS-Bx, n = 2953], and HP-M (high PSA and MRI-TBx, n = 345). The detection rates of PCa and csPCa between groups were compared, and association of biopsy modality with detection of PCa and csPCa in men with low PSA levels were analyzed. The detection rates of PCa (20.0% vs. 38.2%; P < 0.001) and csPCa (11.5% vs. 32.3%; P < 0.001) were higher in the LP-M group than in the LP-T group. Conversely, there were no significant differences in the detection rates of PCa (38.2% vs. 43.2%; P = 0.263) and csPCa (32.3% vs. 39.4%; P = 0.103) between the LP-M and HP-M groups. Multivariate analyses revealed that using MRI-TBx could predict the detection of csPCa (odds ratio 2.872; 95% confidence interval 1.996‒4.132; P < 0.001) in men with low PSA levels. In summary, performing MRI-TBx in men with low PSA levels significantly improved the detection rates of PCa and csPCa as much as that in men with high PSA levels. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the negative predictive value (NPV) of multiparametric magnetic resonance imaging (mpMRI) in detecting clinically significant prostate cancer (csPCa) according to biopsy setting and prostate-specific antigen density (PSAD) using transperineal template-guided saturation prostate biopsy (TPB) as the reference standard. Methods: A total of 161 patients with biopsy histories and negative pre-biopsy mpMRI (Prostate Imaging Reporting and Data System version 2 scores of less than 3) participated in the study. TPB was performed on the following indications: "prior negative biopsy" in patients with persistent suspicion of prostate cancer (n = 91) or "confirmatory biopsy" in patients who were candidates for active surveillance (n = 70). The csPCa was defined as a Gleason score of 3 + 4 or greater. We calculated the NPV of mpMRI in detecting csPCa according to biopsy history and prostate-specific antigen density (PSAD) and conducted a logistic regression analysis to determine the clinical predicator for the absence of csPCa. Results: The detection rate of csPCa was 5.5% in the prior negative biopsy group and 14.3% in the confirmatory biopsy group (P = 0.057). None of the variables in the logistic regression models including PSAD < 0.15 ng/mL/cc and prior negative biopsy could predict the absence of csPCa. The NPV of mpMRI in detecting csPCa in patients with a prior negative biopsy worsen from 94.5% to 93.3% when combined with PSAD < 0.15 ng/mL/cc. Conclusion: Patients with negative mpMRI findings may not omit repeat biopsy even if their prior biopsy histories are negative and PSADs are < 0.15 ng/mL/cc. [ABSTRACT FROM AUTHOR]

Objectives: To develop a model to predict biochemical recurrence (BCR) after radical prostatectomy (RP), using artificial intelligence (AI) techniques. Patients and Methods: This study collected data from 7,128 patients with prostate cancer (PCa) who received RP at 3 tertiary hospitals. After preprocessing, we used the data of 6,755 cases to generate the BCR prediction model. There were 16 input variables with BCR as the outcome variable. We used a random forest to develop the model. Several sampling techniques were used to address class imbalances. Results: We achieved good performance using a random forest with synthetic minority oversampling technique (SMOTE) using Tomek links, edited nearest neighbors (ENN), and random oversampling: accuracy = 96.59%, recall = 95.49%, precision = 97.66%, F1 score = 96.59%, and ROC AUC = 98.83%. Conclusion: We developed a BCR prediction model for RP. The Dr. Answer AI project, which was developed based on our BCR prediction model, helps physicians and patients to make treatment decisions in the clinical follow-up process as a clinical decision support system. [ABSTRACT FROM AUTHOR]

Recent studies reported conflicting results on the association of androgen deprivation therapy (ADT) with dementia and Parkinson's disease in patients with prostate cancer (Pca). Therefore, this study aimed to investigate whether use of gonadotropin-releasing hormone agonist (GnRHa) increases the risk of both diseases. A nationwide population cohort study was conducted involving newly diagnosed patients with Pca %who started ADT with GnRHa (GnRHa users, n = 3,201) and control (nonusers, n = 4,123) between January 1, 2012, and December 31, 2016, using data from the National Health Insurance Service. To validate the result, a hospital cohort of patients with Pca consisting of GnRHa users (n = 205) and nonusers (n = 479) in a tertiary referral center from January 1, 2006 to December 31, 2016, were also analyzed. Traditional and propensity score-matched Cox proportional hazards models were used to estimate the effects of ADT on the risk of dementia and Parkinson's disease. In univariable analysis, risk of dementia was associated with GnRHa use in both nationwide and hospital validation cohort (hazard ratio [HR], 1.696; 95% CI, 1.425–2.019, and HR, 1.352; 95% CI, 1.089–1.987, respectively). In a nationwide cohort, ADT was not associated with dementia in both traditional and propensity score-matched multivariable analysis, whereas in a hospital validation cohort, ADT was associated with dementia only in unmatched analysis (HR, 1.203; 95% CI, 1.021–1.859) but not in propensity score-matched analysis. ADT was not associated with Parkinson's disease in either nationwide and validation cohorts. This population-based study suggests that the association between GnRHa use as ADT and increased risk of dementia or Parkinson's disease is not clear, which was also verified in a hospital validation cohort. [ABSTRACT FROM AUTHOR]

Objectives: The importance of clinical outcome prediction models using artificial intelligence (AI) is being emphasized owing to the increasing necessity of developing a clinical decision support system (CDSS) employing AI. Therefore, in this study, we proposed a "Dr. Answer" AI software based on the clinical outcome prediction model for prostate cancer treated with radical prostatectomy. Methods: The Dr. Answer AI was developed based on a clinical outcome prediction model, with a user-friendly interface. We used 7,128 clinical data of prostate cancer treated with radical prostatectomy from three hospitals. An outcome prediction model was developed to calculate the probability of occurrence of 1) tumor, node, and metastasis (TNM) staging, 2) extracapsular extension, 3) seminal vesicle invasion, and 4) lymph node metastasis. Random forest and k-nearest neighbors algorithms were used, and the proposed system was compared with previous algorithms. Results: Random forest exhibited good performance for TNM staging (recall value: 76.98%), while k-nearest neighbors exhibited good performance for extracapsular extension, seminal vesicle invasion, and lymph node metastasis (80.24%, 98.67%, and 95.45%, respectively). The Dr. Answer AI software consisted of three primary service structures: 1) patient information, 2) clinical outcome prediction, and outcomes according to the National Comprehensive Cancer Network guideline. Conclusion: The proposed clinical outcome prediction model could function as an effective CDSS, supporting the decisions of the physicians, while enabling the patients to understand their treatment outcomes. The Dr. Answer AI software for prostate cancer helps the doctors to explain the treatment outcomes to the patients, allowing the patients to be more confident about their treatment plans. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the efficacy of transperineal template-guided mapping biopsy (TTMB) for patients on active surveillance (AS) or those with previous negative transrectal ultrasound-guided biopsy (TRUS-Bx). Methods: We retrospectively analyzed 99 patients on AS and 60 patients with previous negative TRUS-Bx, which is a total of 159 patients who underwent TTMB from May 2017 to January 2019. Cancer location was analyzed with focus on the anterior and apex lesions of the prostate after TTMB. Multiparametric magnetic resonance imaging was performed before TTMB. Cancer location after TTMB in 138 patients, excluding 21 patients who were not eligible for analysis (4 patients on AS and 17 patients with previous negative TRUS-Bx) was compared with Prostate Imaging-Reporting and Data System version 2 (PI-RADSTM v2) score. Factors that may affect detecting cancer after TTMB with previous negative TRUS-Bx was analyzed using a logistic regression model. Results: In AS patients, 29 patients (29.3%) exhibited an upgrade in Gleason score (GS) after TTMB. Among them, 22 patients (75.9%) showed at the anterior or apex lesions. In patients with previous negative TRUS-Bx, 18 patients (30.0%) were diagnosed with prostate cancer. Among them, 13 patients (72.2%) exhibited cancer at the anterior or apex lesion. Among the 25 AS patients with PI-RADSTM score 1–2, 5 patients (20.0%) showed an upgrade in GS. Among the 26 patients with previous negative TRUS-Bx and PI-RADSTM score 1–2, 6 patients (23.1%) had cancer. In multivariate regression model, prostate volume (OR 0.951) was identified as the predictor for a positive biopsy result after TTMB with previous negative TRUS-Bx. Conclusions: TTMB is efficient for patients on AS in the detection of upgraded cancer located in anterior or apex or those with previous negative TRUS-Bx in the detection of anterior or apex cancer. In PI-RADSTM score 1–2, a substantial proportion of patients after experienced upgrade in GS on AS patients or cancer detection on previous negative TRUS-Bx. Moreover, we identified prostate volume is the independent predictor for a positive biopsy result after TTMB with previous negative TRUS-Bx. [ABSTRACT FROM AUTHOR]

There are many medical demands that still need to be resolved for prostate cancer (PCa), including better diagnosis and predictive medicine. For this to be accomplished, diverse medical data need to be integrated with the development of intelligent software (SW) based on various types of medical data. Various types of information technology have been used to address these medical demands of PCa. We initiated the PROstate Medical Intelligence System Enterprise-Clinical, Imaging, and Pathology (PROMISE CLIP) and a multicenter, big data study to develop PCa SW for patients with PCa and clinicians. We integrated the clinical data of 7257 patients, 610 patients' imaging data, and 39,000 cores of pathology digital scanning data from four tertiary hospitals in South Korea. We developed the PROMISE CLIP registry based on integrated clinical, imaging, and pathology data. Related intelligent SW has been developed for helping patients and clinicians decide on the best treatment option. The PROMISE CLIP study directs guidelines for intelligent SW development to solve medical demands for PCa. The PROMISE CLIP registry plays an important role in advancing PCa research and care. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical usefulness of natural killer cell activity (NKA) for detection of prostate cancer (PCa) and prediction of Gleason grade. Patients and methods: We prospectively enrolled 221 patients who underwent transrectal ultrasound-guided prostate biopsy for suspected PCa due to elevated prostate-specific antigen (PSA) >2.5 ng/mL or abnormal findings on digital rectal examination (n=146), or who were diagnosed with PCa (n=75) between 2016 and 2017. The NKA was compared according to PCa and Gleason grade. Correlation analysis was used to evaluate associations among NKA, PCa, and Gleason grade, and expressed using distribution dot plots. The absolute risk and relative risk of PCa, and odds ratios at different cut-off values of NKA were calculated. Results: Of the total 221 patients, PCa was identified in 135 (61.9%) patients. When patients were divided according to PCa, there was no significant difference in NKA (1,267.6 vs 1,198.9 pg/mL, P=0.491). Furthermore, in 135 patients with PCa, the NKA was not significantly different according to Gleason grade (P=0.893). These results were not changed when confined to the patients with PSA between 2.5 and 10.0 ng/mL (P=0.654 and P=0.672, respectively). In addition, there was no significant difference in the risk of PCa at different cut-off values of NKA. Conclusion: These results indicate that NKA does not appear to be very useful for detection of PCa and prediction of Gleason grade. Further large multi-institutional studies are required to verify the role of NKA in PCa detection and Gleason grade prediction. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of race on the risk of pathological upgrading and upstaging at radical prostatectomy (RP) in an Asian (Korean) and Western (Caucasian) cohort eligible for active surveillance (AS). Materials and methods: We performed a retrospective cohort study of 854 patients eligible for AS who underwent RP in United States (n = 261) and Korea (n = 593) between 2006 and 2015. After adjusting for age, PSA level, and prostate volume, we utilized multivariate logistic regression analysis to assess the effect of race on upgrading or upstaging. Results: There were significant differences between Caucasian and Korean patients in terms of age at surgery (60.2 yr. vs. 64.1 yr.), PSA density (0.115 ng/mL/mL vs. 0.165 ng/mL/mL) and mean number of positive cores (3.5 vs. 2.4), but not in preoperative PSA values (5.11 ng/mL vs. 5.05 ng/mL). The rate of upstaging from cT1 or cT2 to pT3 or higher was not significantly different between the two cohorts (8.8% vs. 11.0%, P = 0.341). However, there were higher rates of upgrading to high-grade cancer (Gleason 4+3 or higher) in Korean patients (9.1%) when compared to Caucasian counterparts (2.7%) (P = 0.003). Multivariate logistic regression analysis showed that age (OR 1.07, P < 0.001) and smaller prostate volume (OR 0.97, P < 0.001), but not race, were significantly associated with upstaging or upgrading. Conclusions: There were no differences in rates of upgrading or upstaging between Caucasian and Korean men eligible for active surveillance. [ABSTRACT FROM AUTHOR]

Introduction: We investigated the accuracy of multiparametric MRI (mpMRI) for preoperative staging and its influence on the determination of neurovascular bundle sparing and disease prognosis in patients with localized prostate cancer. Methods: We reviewed 1045 patients who underwent radical prostatectomy with preoperative mpMRI at a single institution. Clinical local stages determined from mpMRI were correlated with preoperative and postoperative pathological outcomes. Results: The sensitivity and specificity to diagnose seminal vesicle invasion (SVI) on mpMRI were 43.8 and 95.4 %, respectively. The negative predictive value was 78.9 %. The sensitivity and specificity to diagnose extracapsular extension (ECE) were 54.5 and 80.5 %, respectively. The overall sensitivity and specificity of diagnosing pathological T3 or higher were 52.6 and 82.1 %, respectively. Non-organ-confined disease determined by mpMRI was significantly associated with positive surgical margin and pathological T3 disease on multivariate analysis. Preoperative adverse findings on mpMRI were significantly associated with performance of the non-nerve-sparing technique. Conclusion: mpMRI did not show outstanding diagnostic accuracy relative to our expectations in predicting SVI or ECE preoperatively. However, adverse findings on preoperative mpMRI were significantly related to worse postoperative pathological outcomes as well as postoperative biochemical recurrence. [ABSTRACT FROM AUTHOR]

Objective:The aim of this study was to develop a nomogram to predict the probability of insignificant prostate cancer. Materials and methods:A retrospective analysis was conducted of patients who underwent radical prostatectomy at a Korean hospital between January 2005 and December 2014. Patients with pathologically insignificant prostate cancer were defined as having organ-confined disease with tumor volume less than 0.5 cm³ without Gleason scores of 4 or 5. Multivariable logistic regression analysis with a stepwise selection was used to model the relationship between preoperative characteristics and insignificant prostate cancer, and a nomogram to predict the probability of insignificant prostate cancer was created. Receiver operating characteristics (ROC) analysis was performed to assess the predictive value of the model. Results:The final study population consisted of 1343 patients. Among these patients, insignificant prostate cancer was confirmed in 188 men (14.0%) at the time of prostatectomy. Six independent predictors of insignificant prostate cancer were identified: number of positive cores (p < 0.001), maximal single core tumor involvement (p < 0.001), biopsy Gleason score (p < 0.001), prostate volume (p = 0.024), patient age (p < 0.001) and prostate-specific antigen density (p < 0.001) in the multivariable model. A nomogram to predict insignificant prostate cancer was developed using these six preoperative characteristics. The area under the ROC curve for nomogram predictions was 0.87. Conclusion:The nomogram developed in this paper identifies the probability of insignificant prostate cancer and gives providers more information to guide their clinical decisions. [ABSTRACT FROM PUBLISHER]

Objectives To evaluate the oncological outcome and to assess prognostic factors of salvage radiotherapy alone in patients with biochemical recurrence after radical prostatectomy. Methods We reviewed our single institution, prospectively maintained database of 2043 patients who underwent radical prostatectomy between September 1995 and December 2011. In this cohort, 149 patients who developed biochemical recurrence after radical prostatectomy and received salvage radiotherapy alone after pelvic magnetic resonance imaging were included. Three-dimensional conformal radiotherapy or intensity-modulated radiotherapy was delivered with a median dose of 70.0 Gy (66.0-78.0 Gy) or 67.2 Gy (64.8-70.0 Gy). Kaplan-Meier and Cox regression analyses were carried out. Results With a median follow up of 82 months (range 20-153 months), 55 patients (36.9%) failed salvage radiotherapy. The 5-year salvage radiotherapy failure-free probability was 53.6%. On multivariate analysis, pre-salvage radiotherapy prostate-specific- antigen ≥1.0 ng/mL ( P = 0.003, hazard ratio 3.592, 95% confidence interval 1.522-8.579), pathological stage ≥T3a ( P = 0.004, hazard ratio 2.261, 95% confidence interval 1.290-3.833), pathological Gleason score ≥7 ( P = 0.018, hazard ratio 5.501, 95% confidence interval 1.577-21.221), prostate-specific antigen doubling time <12 months ( P = 0.014, hazard ratio 2.243, 95% confidence interval 1.177-4.275) and no visible lesion on pelvic magnetic resonance imaging ( P = 0.016, hazard ratio 2.068, 95% confidence interval 1.268-3.501) were independent prognostic factors of salvage radiotherapy failure after radical prostatectomy. Conclusions Pre-salvage radiotherapy prostate-specific antigen ≥1.0 ng/mL, pathological stage ≥T3a, pathological Gleason score ≥7, prostate-specific antigen doubling time <12 months and no visible lesion on pelvic magnetic resonance imaging are prognostic factors of salvage radiotherapy failure after radical prostatectomy. We should consider additional treatment in patients with these factors for favorable outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether the apparent diffusion coefficient (ADC) from diffusion-weighted magnetic resonance imaging (DW-MRI) could help improve the prediction of insignificant prostate cancer in candidates for active surveillance (AS). Methods: Enrolled in this retrospective study were 287 AS candidates who underwent DW-MRI before radical prostatectomy. Patients were stratified into two groups; Group A consisted of patients with no visible tumour or a suspected tumour ADC value > 0.830 × 10 mm/sec and Group B consisted of patients with a suspected tumour ADC value < 0.830 × 10 mm/sec. We compared pathological outcomes in each group. Results: Group A had 243 (84.7 %) patients and Group B had 44 (15.3 %) patients. The proportion of organ-confined Gleason ≤ 6 disease and insignificant prostate cancer was significantly higher in Group A than Group B (61.3 % vs. 38.6 %, p = 0.005 and 47.7 % vs. 25.0 %, p = 0.005, respectively). On multivariate analysis, a high ADC value was the independent predictor of organ-confined Gleason ≤ 6 disease and insignificant prostate cancer (odds ratio = 2.43, p = 0.011 and odds ratio = 2.74, p = 0.009, respectively). Conclusion: Tumour ADC values may be a useful marker for predicting insignificant prostate cancer in candidates for AS. Key points: • ADC from DW-MRI can help assess prostate cancer aggressiveness in potential AS candidates. • There was a closed correlation between higher ADC values and insignificant prostate cancer. • The absence of lesions on DWI/DWI can help select potential AS candidates. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively compare re-biopsy with preceded magnetic resonance imaging (MRI) and re-biopsy without preceded MRI. Materials and methods: Between January 2007 and May 2011, 669 patients (mean 64 years; range 38-91 years) underwent a re-biopsy because of previous negative biopsy (median 1; 1-5) and persistently high prostate-specific antigen (PSA 10.6 ng/ml; 2.5-997.1 ng/ml). 3T MRI using a phased-array coil was performed in 171 (MRI group) but not in 498 (non-MRI group) prior to re-biopsy. Transrectal ultrasound-guided biopsy was performed in both MRI and non-MRI groups. MRI and non-MRI groups were compared in terms of cancer detection rate [(number of cancer-proven patients/number of patients in MRI or non-MRI group) × 100] and positive core rate [(number of cancer-positive cores/number of cores in MRI or non-MRI group) × 100] using Fisher exact test. Odds ratio and 95% confidence interval were also obtained. Pathologic diagnosis of the biopsy was considered standard reference. Results: Of 669 patients, 129 (19.3%) were diagnosed with adenocarcinoma. The cancer detection rates of MRI and non-MRI groups were 33.3% (57/171) and 14.5% (72/498), respectively ( p < 0.001). The positive core rates of these groups were 9.2% (167/1 818) and 3.2% (179/5 631), respectively ( p < 0.001). The odd ratios of cancer detection rate and positive core rate were 3.0 (95% confidence interval 2.0-4.4) and 3.1 (2.5-3.8), respectively. Conclusion: Re-biopsy with preceded MRI yields higher cancer detection rate and positive core rate than re-biopsy without preceded MRI. MRI should be considered prior to re-biopsy in patients with previous negative biopsy and persistently high PSA. [ABSTRACT FROM AUTHOR]

Objectives To assess the use of post-salvage radiotherapy prostate-specific antigen for early prediction of biochemical failure or clinical recurrence after salvage radiotherapy in recurrent prostate cancer patients after prostatectomy. Methods From 2000 to 2011, 164 patients were treated with salvage radiotherapy alone for recurrent prostate cancer. Patients who received androgen deprivation therapy before or within 1 month of the termination of salvage radiotherapy were excluded. Survival analysis was carried out with: (i) a selected prostate-specific antigen reference value (0.2 ng/mL) at the second follow-up period (4 months) after salvage radiotherapy (prostate-specific antigen value over 0.2 ng/mL at post-salvage radiotherapy 4 months); and (ii) prostate-specific antigen percent decline (post-salvage radiotherapy 4 months prostate-specific antigen/pre-salvage radiotherapy prostate-specific antigen). Results The median follow-up time was 53.4 months (range 8.5-134.1 months). The 5-year clinical recurrence-free survival was 87.9%. Prostate-specific antigen percent decline of 0.45 was set as the cut-off value for clinical recurrence-free survival based on the receiver operating characteristics curve. In the multivariate analysis, a prostate-specific antigen value over 0.2 ng/mL at post-salvage radiotherapy 4 months ( P = 0.013) and prostate-specific antigen percent decline ≥ 0.45 ( P = 0.002) were both significant parameters predicting clinical recurrence-free survival. Otherwise, prostate-specific antigen percent decline ≥ 0.45 was the only statistically significant predictor of biochemical failure-free survival (biochemical failure-free survival after salvage radiotherapy). Conclusions A prostate-specific antigen value over 0.2 ng/mL at post-salvage radiotherapy 4 months and prostate-specific antigen percent decline ≥ 0.45 are negative predictors of clinical recurrence-free survival after salvage radiotherapy. Prostate-specific antigen percent decline ≥ 0.45 is also associated with worse biochemical failure-free survival after salvage radiotherapy. Patients with delayed prostate-specific antigen decrease should be carefully observed for clinical recurrence. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the accuracy of preoperative multiparametric 3.0-T magnetic resonance imaging for local staging of prostate cancer and its influence in the decision to preserve neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. Materials and Methods: The study included 353 patients who had confirmed prostate cancer and underwent preoperative magnetic resonance imaging and robotic assisted laparoscopic radical prostatectomy between 2008 and 2011. The extent of neurovascular bundle sparing was initially determined on the basis of the clinical information and the nerve sparing surgical plan was reevaluated after review of the magnetic resonance imaging report. The value of preoperative magnetic resonance imaging in the prediction of extracapsular extension and in the decision of surgical plan according to D'Amico risk classification was analyzed. Results: The magnetic resonance imaging performed correct staging, over staging and under staging in 261 (73.9%), 43 (12.2%), and 49 (13.9%) patients, respectively. After review of the magnetic resonance imaging reports, the initial surgical plan was not changed in 260 patients (74%) and was changed in 93 patients (26%). Robotic assisted laparoscopic radical prostatectomy was changed to a more preservable neurovascular bundle sparing procedure in 53 patients (57%) and changed to a more aggressive neurovascular bundle resecting procedure in 40 patients (43%). For the patients with a change to more conservative surgery, the appropriateness was 91%. The sensitivity of magnetic resonance imaging in predicting extracapsular extension showed a tendency to increase from low to high risk groups (33%, 46%, 80%, respectively, p <0.001). In intermediate and high risk groups, there was a surgical plan change in 40 patients (of 129, 31%) and 27 patients (of 67, 40%), respectively. Conclusions: Preoperative magnetic resonance imaging significantly improves the decision making to preserve or resect the neurovascular bundle at robotic assisted laparoscopic radical prostatectomy, which lacks haptic feedback. [Copyright &y& Elsevier]

Objectives To investigate the ability of six contemporary active surveillance protocols to appropriately select active surveillance candidates among Korean men who underwent radical prostatectomy. Methods Between January 2001 and December 2011, 1968 patients underwent radical prostatectomy for prostate cancer at Samsung Medical Center, Seoul, Korea. Patients met the criteria for active surveillance according to six currently used criteria, including those from the Johns Hopkins Hospital, the University of Toronto, the University of California at San Francisco, the Prospective Prostate Cancer Research International Active Surveillance, the University of Miami and the Memorial Sloan- Kettering Cancer Center. The rates of Gleason score upgrading, upstaging and misclassification at final pathology were assessed. Results Among 1006 assessable patients, the percentage of men eligible for active surveillance varied from 13.5% to 38.5%, depending on the criteria used. The rates of upgrading ranged from 41.6% to 50.6%. Extracapsular extension was reported in 4.1% to 8.5% of patients, whereas seminal vesicle invasion was reported in 0.5% to 1.6% of patients. The upstaging rates according to the six active surveillance criteria varied from 4.5% to 9.3%, and the rates of misclassification varied from 44.5% to 54.8%. Conclusions Currently available active surveillance criteria might not be suitable in Korean patients with prostate cancer, as they have a high likelihood of underestimating cancer. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the psychometric properties of the Korean version of the European Organization for Research and Treatment of Cancer QLQ-PR25 when applied to Korean prostate cancer (PC) patients. Methods: A total of 172 patients who underwent curative radical prostatectomy (RP) with or without adjuvant androgen deprivation therapy were asked to complete the Korean version of the EORTC QLQ-C30 and PR25 questionnaires 3 times (before and 3 and 6 months after RP). Psychometric evaluation of the questionnaire was conducted. Results: Multitrait scaling analysis showed satisfactory construct validity in most scales except for bowel symptoms and hormonal treatment-related symptoms. Internal consistency tested by Cronbach's α coefficient met the 0.70 criterion for the urinary symptom, sexual activity and sexual functioning scales at the all 3 time points. Known-group comparison analyses showed better quality-of-life (QOL) scores in patients with higher performance status, and higher hormonal treatment-related symptom scores in patients on hormonal treatment. Responsiveness to changes was in line with clinical implications over time after RP. Conclusions: Our results show that the EORTC QLQ-PR25 questionnaire has adequate levels in cross-cultural validity. The Korean version of the EORTC QLQ-PR25 is a generally reliable and robust instrument for the assessment of various QOL aspects that can be self-administered to Korean PC patients undergoing RP. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: To investigate the factors that predict recovery of continence within 3 months after robot-assisted radical prostatectomy (RARP). Patients and Methods: The charts of 452 patients who underwent RARP with a minimum follow-up period of 3 months were collected prospectively and reviewed retrospectively. Urinary continence was determined using the self-administered validated Expanded Prostate Cancer Index Composite questionnaire during the routine follow-up visits. Results: The overall continence rate 3 months after RARP was 79.9%. In an univariate logistic regression test, age<70 years, higher preoperative Sexual Health Inventory for Men (SHIM) score, lower clinical T1 stage, lower biopsy and pathologic Gleason score, shorter operative time, lower estimated blood loss, smaller prostate volume (<40 cc) were associated with recovery of urinary continence within 3 months after RARP ( P<0.05). In multivariate logistic regression analysis, younger age, higher SHIM score, lower clinical T1 stage, lower body mass index (BMI), and smaller prostate volume were independent factors that predicted return of continence within 3 months after RARP ( P<0.05). Conclusions: Younger age (<70 years), higher preoperative SHIM score, clinical T1 stage, lower BMI, and smaller prostate volume (<40 cc) independently predicted recovery of continence within 3 months after RARP. [ABSTRACT FROM AUTHOR]

AbstractPurpose:To directly compare the outcome of laparoscopic radical prostatectomy (LRP) with robot-assisted laparoscopic prostatectomy (RALP) performed by a single laparoscopic surgeon with intermediate experience—one who is between a novice and an expert.Patients and Methods:Consecutive 106 patients with prostate cancer who were treated with radical prostatectomy (62 with LRP and 44 with RALP) were included. The preoperative characteristics, the perioperative surgical outcomes, and the functional outcomes were compared between the two groups.Results:The mean operative time was longer in the RALP group (371 min vs308 min, P= 0.00), conceivably because of more nerve-sparing procedures (84% vs57%). The other perioperative parameters, including the surgical margin, were comparable, except for two major complications (rectourethral fistula and ureteral injury) in the LRP group. The RALP group recovered continence faster than those in the LRP, but the eventual continence rate at 12 months was similar (95% for LRP vs94.4% for RALP, P= 1.00). The potency rate ≥ 6 months postsurgery was 47.6% in the LRP group and 54.5% in the RALP group (P= 0.65).Conclusions:RALP was beneficial for the earlier recovery of continence, although LRP and RALP had comparable safety and efficacy as minimally invasive surgery for prostate cancer when performed by a laparoscopic surgeon with intermediate experience. Long-term follow-up data are needed for further evaluation of oncologic and functional outcomes for both techniques. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the detection rate and pathology of cancer in Korean men with low levels of prostate-specific antigen (PSA), 2.5-4.0 ng/mL. Methods: We examined 1097 patients with PSA level of 2.5-10.0 ng/mL, who underwent transrectal ultrasonography-guided prostate needle biopsies between January 2008 and March 2009. Of the 1097 biopsy patients, 815 met our criteria of benign findings by digital rectal examination and the absence of cancerous lesions by TRUS. Clinical characteristics and detection rates of prostate cancer, as well as the pathology of specimens obtained by needle biopsies and prostatectomies, were evaluated in these patients. Results: Of the 815 patients, 349 had group 1 (PSA level, 2.5-4.0 ng/mL) and 466 had group 2 (PSA level, 4.0-10.0 ng/mL). The percentage of patients diagnosed with prostate cancer was not statistically different between the 2 groups (21.8% in group 1, and 20.2% in group 2). In group 1, 70.7% of patients had a pathologic Gleason score of 7 or higher and 91.4% had organ-confined tumors (pT2). The pathologic characteristics, including Gleason score, pathologic stage, and percentage of insignificant cancer were similar in prostatectomy specimens between group 1 and group 2. Conclusions: Detection rates of nonpalpable prostate cancer in Korean men were 21.8% in group 1 and 20.2% in group 2 without statistically significant difference. Pathologic characteristics of prostatectomy specimens also were similar between group 1 and group 2. These results suggest that a lower PSA level might be considered as an indication for prostate biopsy. [ABSTRACT FROM AUTHOR]

Simple Summary: As sarcopenia is recognized as a poor prognostic factor in various type of cancers, we hypothesized that sarcopenia may also have adverse impact in patients with metastatic hormone-sensitive prostate cancer (mHSPC). In this study, we found that sarcopenia is an independent prognostic factor for poor failure-free survival and time to prostate-specific antigen progression in patients with mHSPC who receive early docetaxel or abiraterone acetate treatment. In addition, we performed RNA sequencing of primary tumors to further understand the biological perspective of the presence of sarcopenia in mHSPC. Transcriptomic differences were found between primary tumors with and without sarcopenia, which may have a potential to link between sarcopenia and poor clinical outcomes in these patients. The clinical value of sarcopenia has not been determined yet in metastatic hormone-sensitive prostate cancer (mHSPC). We retrospectively evaluated data of 70 consecutive patients with mHSPC receiving treatment with either early docetaxel (n = 42) or abiraterone acetate (n = 28) between July 2018 and April 2021. Skeletal muscle index was calculated from cross-sectional areas of skeletal muscle on baseline computed tomography (CT), defining sarcopenia as a skeletal muscle index of ≤52.4 cm2/m2. Failure-free survival (FFS), radiographic progression-free survival, and time to prostate-specific antigen (PSA) progression were estimated using the Kaplan–Meier method, and differences in survival probability were compared using the log-rank test. Cox proportional hazards regression analysis was conducted to identify the predictors of clinical outcomes. Patients with sarcopenia (n = 47) had shorter FFS than those without sarcopenia (n = 23) (median, 20.1 months vs. not reached; log-rank p < 0.001). Sarcopenia was independently associated with shorter FFS (hazard ratio (HR), 6.69; 95% confidence interval (CI), 1.57–28.49; p = 0.010) and time to PSA progression (HR, 12.91; 95% CI, 1.08–153.85; p = 0.043). In conclusion, sarcopenia is an independent prognostic factor for poor FFS and time to PSA progression in patients with mHSPC who receive early docetaxel or abiraterone acetate treatment. [ABSTRACT FROM AUTHOR]

Intraductal carcinoma of the prostate (IDC-P) is a rare and unique form of aggressive prostate carcinoma, which is characterized by an expansile proliferation of malignant prostatic epithelial cells within prostatic ducts or acini and the preservation of basal cell layers around the involved glands. The vast majority of IDC-P tumors result from adjacent high-grade invasive cancer via the retrograde spreading of tumor cells into normal prostatic ducts or acini. A subset of IDC-P tumors is rarely derived from the de novo intraductal proliferation of premalignant cells. The presence of IDC-P in biopsy or surgical specimens is significantly associated with aggressive pathologic features, such as high Gleason grade, large tumor volume, and advanced tumor stage, and with poor clinical courses, including earlier biochemical recurrence, distant metastasis, and worse survival outcomes. These architectural and behavioral features of IDC-P may be driven by specific molecular properties. Notably, IDC-P possesses distinct genomic profiles, including higher rates of TMPRSS2–ERG gene fusions and PTEN loss, increased percentage of genomic instability, and higher prevalence of germline BRCA2 mutations. Considering that IDC-P tumors are usually resistant to conventional therapies for prostate cancer, further studies should be performed to develop optimal therapeutic strategies based on distinct genomic features, such as treatment with immune checkpoint blockades or poly (adenosine diphosphate–ribose) polymerase inhibitors for patients harboring increased genomic instability or BRCA2 mutations, as well as genetic counseling with genetic testing. Patient-derived xenografts and tumor organoid models can be the promising in vitro platforms for investigating the molecular features of IDC-P tumor. [ABSTRACT FROM AUTHOR]

Background: To identify the role of combination biopsy, which consists of both targeted and additional systematic cores, in the diagnosis of clinically significant prostate cancer (csPCa). Methods: We retrospectively reviewed patients with PSA levels 2.5–15 ng/mL who have a suspicious prostate lesion (with the Prostate Imaging Reporting and Data System (PI-RADS) ≥ 3) on multiparametric MRI (mpMRI) between January 2016 and December 2018. We analyzed biopsy results by PI-RADS score and biopsy methods (systematic, targeted, and combination biopsy). Results: Of the 711 total patients, an average of 4.0 ± 1.8 targeted and 8.6 ± 3.1 additional systematic biopsies were performed. The additional systematic biopsies were sampled outside the targeted biopsy area. The combination biopsies detected more csPCa (201 patients, 28.3%) than did the targeted (175 patients, 24.6%) or systematic (124 patients, 17.4%) biopsies alone (p < 0.001). In the initial biopsy samples, there was a 7% increase in the detection of csPCa than in targeted biopsy (62% to 69%). It increased by 11% in repeat biopsy (46% to 57%). There was no statistical significance in both groups (p = 0.3174). Conclusions: Combination biopsy has the benefit of detecting csPCa in both initial and repeat biopsy when there is a suspicious lesion on mpMRI. [ABSTRACT FROM AUTHOR]

Background: Results from randomized phase III trials have shown that thrice-weekly docetaxel added to androgen-deprivation therapy (ADT) has a significant impact on the survival of patients with metastatic castration-naïve prostate cancer (mCNPC) and established early chemotherapy as part of the standard of care for high-risk disease. Controversy remains, however, because some patients experience critical toxicities related to docetaxel. The purpose of the current study was to evaluate the feasibility and adverse events of biweekly-administered docetaxel in patients with previously-untreated, high-risk mCNPC.Methods: The study included 35 consecutive patients with high-risk mCNPC who received ADT plus docetaxel 40 mg/m2. Oral prednisone 5 mg twice daily was also given. Treatment was repeated every two weeks for up to 12 cycles or until disease progression or unacceptable toxicity occurred. High-risk was defined as bone metastases beyond axial skeleton and/or visceral disease.Results: The included patients' median age was 68 years (range: 31-86 years) and 17 (49%) had visceral metastases. Biweekly docetaxel was generally well-tolerated; the most commonly observed adverse events, considering those of all grades, included alopecia (74%), nail changes (42%), and constipation (31%). Hematologic adverse events were infrequent, and no patient received hematopoietic growth factors. One patient died after the fourth cycle due to respiratory failure, which occurred as a complication of pneumonia. Among the 35 patients, 28 completed the planned 12 cycles of biweekly docetaxel. Prostate-specific antigen response (> 50% decrease from baseline) was recorded in 33 patients (94%), and the radiologic response rate was 49%. Median progression-free survival was 13.6 months (95% confidence interval: 6.7-20.4).Conclusion: ADT plus biweekly-administered docetaxel appeared to be tolerated and effective in patients with high-risk mCNPC. [ABSTRACT FROM AUTHOR]

Introduction: Pathological stage of prostate cancer is one of the most crucial predictors of oncological outcome. Prostate biopsy findings are commonly used for predicting outcome, however, the results of prostate biopsy often diverge from the final pathological analysis. We investigated prostate cancer patients with unilateral positive biopsy to determine which factors would be predictive of unilateral disease on radical prostatectomy specimen. Methods: This study included 162 patients with unilateral positive biopsy who underwent radical perineal prostatectomy for prostate cancer between June 1995 and May 2007. We retrospectively reviewed the clinical and pathological data of the population. Preoperative PSA density, biopsy core number, biopsy Gleason score, maximum tumor volume percentage on biopsy core and clinical stage were analyzed according to prostatectomy pathology (unilateral versus bilateral disease). Results: Of 162 patients with unilateral positive biopsy 103 (63.2%) had tumor(s) on contralateral lobe. In univriate analysis the maximum tumor volume percentage on biopsy core was significantly higher in patients with bilateral disease than in those with unilateral disease (27.5% versus 37.3%, P=0.014). However, any clinical and biopsy information were not significant predictors for unilateral disease on radical prostatectomy specimen. Conclusions: About two thirds of prostate cancer patients with unilateral positive biopsy had tumor(s) on the contralateral lobe. A unilateral positive biopsy does not predict unilateral disease. These findings may help to assess the risk and the benefit of the radical prostatectomy for prostate cancer patients. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: To assess the location of recurrent tumors and suggest the optimal target volume in adjuvant or salvage radiotherapy (RT) after a radical prostatectomy (RP). Material and methods: From January 2000 to December 2012, 113 patients had been diagnosed with suspected recurrent prostate cancer by MRI scan and received salvage RT in the Samsung Medical Center. This study assessed the location of the suspected tumor recurrences and used the inferior border of the pubic symphysis as a point of reference. Results: There were 118 suspect tumor recurrences. The most common site of recurrence was the anastomotic site (78.8%), followed by the bladder neck (15.3%) and retrovesical area (5.9%). In the cranial direction, 106 (87.3%) lesions were located within 30mm of the reference point. In the caudal direction, 12 lesions (10.2%) were located below the reference point. In the transverse plane, 112 lesions (94.9%) were located within 10mm of the midline. Conclusions: A MRI scan acquired before salvage RT is useful for the localization of recurrent tumors and the delineation of the target volume. We suggest the optimal target volume in adjuvant or salvage RT after RP, which includes 97% of suspected tumor recurrences. [Copyright &y& Elsevier]