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Abstract Background Given the high prevalence of BPH among elderly men, pinpointing those at elevated risk can aid in early intervention and effective management. This study aimed to explore that polygenic risk score (PRS) is effective in predicting benign prostatic hyperplasia (BPH) incidence, prognosis and risk of operation in Han Chinese. Methods A retrospective cohort study included 12,474 male participants (6,237 with BPH and 6,237 non-BPH controls) from the Taiwan Precision Medicine Initiative (TPMI). Genotyping was performed using the Affymetrix Genome-Wide TWB 2.0 SNP Array. PRS was calculated using PGS001865, comprising 1,712 single nucleotide polymorphisms. Logistic regression models assessed the association between PRS and BPH incidence, adjusting for age and prostate-specific antigen (PSA) levels. The study also examined the relationship between PSA, prostate volume, and response to 5-α-reductase inhibitor (5ARI) treatment, as well as the association between PRS and the risk of TURP. Results Individuals in the highest PRS quartile (Q4) had a significantly higher risk of BPH compared to the lowest quartile (Q1) (OR = 1.51, 95% CI = 1.274–1.783, p

Background: Given the high prevalence of BPH among elderly men, pinpointing those at elevated risk can aid in early intervention and effective management. This study aimed to explore that polygenic risk score (PRS) is effective in predicting benign prostatic hyperplasia (BPH) incidence, prognosis and risk of operation in Han Chinese. Methods: A retrospective cohort study included 12,474 male participants (6,237 with BPH and 6,237 non-BPH controls) from the Taiwan Precision Medicine Initiative (TPMI). Genotyping was performed using the Affymetrix Genome-Wide TWB 2.0 SNP Array. PRS was calculated using PGS001865, comprising 1,712 single nucleotide polymorphisms. Logistic regression models assessed the association between PRS and BPH incidence, adjusting for age and prostate-specific antigen (PSA) levels. The study also examined the relationship between PSA, prostate volume, and response to 5-α-reductase inhibitor (5ARI) treatment, as well as the association between PRS and the risk of TURP. Results: Individuals in the highest PRS quartile (Q4) had a significantly higher risk of BPH compared to the lowest quartile (Q1) (OR = 1.51, 95% CI = 1.274–1.783, p < 0.0001), after adjusting for PSA level. The Q4 group exhibited larger prostate volumes and a smaller volume reduction after 5ARI treatment. The Q1 group had a lower cumulative TURP probability at 3, 5, and 10 years compared to the Q4 group. PRS Q4 was an independent risk factor for TURP. Conclusions: In this Han Chinese cohort, higher PRS was associated with an increased susceptibility to BPH, larger prostate volumes, poorer response to 5ARI treatment, and a higher risk of TURP. Larger prospective studies with longer follow-up are warranted to further validate these findings. Key points: Question What is the role of polygenic risk score (PRS) in predicting the incidence and treatment outcome of benign prostatic hyperplasia (BPH) in Han Chinese? Findings In this hospital-based genome-wide association study (GWAS) involving 23,407 male participants, it was discovered that Han Chinese individuals with a higher polygenic risk score (PRS) showed an increased susceptibility to benign prostatic hyperplasia (BPH). Furthermore, patients with elevated PRS exhibited higher levels of prostate-specific antigen (PSA), larger prostate volume, a diminished response to 5-alpha-reductase inhibitor (5ARI) treatment, and a heightened risk of undergoing transurethral resection of the prostate (TURP). Meaning These findings indicate that PRS can be a valuable predictive tool for assessing the risk of BPH incidence and treatment outcomes in male Han Chinese individuals. However, further large-scale studies with longer follow-up periods are necessary to validate these findings and establish the clinical utility of PRS in BPH management. [ABSTRACT FROM AUTHOR]

Occurrence of clear cell carcinoma of the prostate is exceedingly rare and presents a diagnostic dilemma. We describe a case of a 47-year-old male nonsmoker, who presented with a history of frequency, dribbling urination, and dysuria for 6 months. In a digital rectal exam, enlarged prostate with a hard consistency was identified. All results for hematological and biochemical tests were normal. Also, the serum prostate-specific antigen (PSA) level was 2.7 ng/mL (within normal range). Open prostatectomy was done and the result showed a 300 g specimen, and a histopathological examination revealed clear cell carcinoma. A computerized tomography scan and ultrasound did not show any mass in the kidneys, but three nodules in both lungs in favor of metastasis were identified. Three months after surgery, a PET scan revealed hyperactivity in the abdominal wall, pelvic lymph nodes, and lung fields in favor of metastasis; thereafter, systemic therapy with tyrosine kinase inhibitor was prescribed. To the best of our knowledge, clear cell carcinoma of the prostate has been reported very rarely.

The treatment paradigm for non-metastatic castration-resistant prostate cancer (nmCRPC) has changed in recent years. An observational multicenter study was conducted to evaluate the effectiveness of androgen receptor signaling inhibitors (ARSIs) as a first-line treatment for patients with nmCRPC. The present study included native Japanese patients from four hospitals who received ARSIs as a first-line treatment for nmCRPC. The primary endpoint of the study was to evaluate the efficacy and safety of ARSI in patients with nmCRPC. The secondary endpoint was to develop a novel system to stratify the prognoses of these patients. In total, 160 patients were included in the present study. Within a median follow-up period of 23 months, the median overall survival (OS) was not reached, whereas the median progression-free survival was 26 months. Multivariate Cox regression analyses showed that the time to CRPC, prostate-specific antigen (PSA) level at the initiation of nmCRPC treatment and Geriatric Nutritional Risk Index (GNRI) were independent predictors of OS. The patients for whom information about all three independent OS predictors was available were subsequently divided into three groups as follows: Group 1, 57 patients with negative or one positive independent OS predictor; group 2, 38 patients with two positive independent OS predictors; and group 3, 10 patients with three independent OS predictors. The OS differed significantly among the three groups (P<0.0001). In conclusion, ARSIs as a first-line treatment may be associated with favorable outcomes in Japanese patients with nmCRPC. Time to CRPC, PSA level at the initiation of nmCRPC treatment and GNRI are potential predictors of OS in Japanese patients with nmCRPC who received ARSIs as a first-line treatment. [ABSTRACT FROM AUTHOR]

Occurrence of clear cell carcinoma of the prostate is exceedingly rare and presents a diagnostic dilemma. We describe a case of a 47-year-old male nonsmoker, who presented with a history of frequency, dribbling urination, and dysuria for 6 months. In a digital rectal exam, enlarged prostate with a hard consistency was identified. All results for hematological and biochemical tests were normal. Also, the serum prostate-specific antigen (PSA) level was 2.7 ng/mL (within normal range). Open prostatectomy was done and the result showed a 300 g specimen, and a histopathological examination revealed clear cell carcinoma. A computerized tomography scan and ultrasound did not show any mass in the kidneys, but three nodules in both lungs in favor of metastasis were identified. Three months after surgery, a PET scan revealed hyperactivity in the abdominal wall, pelvic lymph nodes, and lung fields in favor of metastasis; thereafter, systemic therapy with tyrosine kinase inhibitor was prescribed. To the best of our knowledge, clear cell carcinoma of the prostate has been reported very rarely. [ABSTRACT FROM AUTHOR]

Background: To analyze oncological outcomes of very high-risk patients with initial PSA 50-99.9 and ≥100 ng/ml who underwent radical prostatectomy (RP) for clinically localized prostate cancer.Methods: Overall, 2,811 RP patients (1992-2018) with negative preoperative CT-scan and bone scintigraphy were included. The impact of preoperative PSA level, categorized as 20-49.9 (n = 2,195) vs. 50-99.9 (n = 454) vs. ≥100 ng/ml (n = 162) on biochemical recurrence (BCR)-free survival, metastasis-free survival (MFS) and cancer-specific survival (CSS) was assessed using Kaplan-Meier and multivariable Cox regression models.Results: Median follow-up was 47.5 months. Ten-year BCR-free survival rates were 46.9 vs. 32.1 vs. 29.0% within PSA-categories 20-49.9 vs. 50-99.9 vs. ≥100 ng/ml, respectively (P < 0.001). Ten-year MFS rates were 78.4 vs. 67.2 vs. 37.3% within PSA-categories 20-49.9 vs. 50-99.9 vs. ≥100 ng/ml (P < 0.001). 10-year CSS rates were 93.7 vs. 85.5 vs. 66.7% within PSA-categories 20-49.9 vs. 50-99.9 vs. ≥100 ng/ml (P < 0.001). In multivariable analyses, PSA-categories 50-99.9 ng/ml and ≥100 ng/ml were independently predicting higher risk of BCR (hazard ratio [HR]: 1.3 and 1.4), metastatic progression (HR: 1.4 and 2.3), and cancer-specific mortality (CSM, HR: 1.9 and 3.4) compared with PSA-category 20-49.9 ng/ml.Conclusion: Initial PSA levels ≥50 ng/ml are associated with higher risk of BCR, metastatic progression, and CSM compared with high-risk patients with PSA of 20-49.9 ng/ml. In consequence, these patients may be counseled about a potentially increased risk of undetected metastases prior to RP possibly necessitating intensified multimodal treatments in the future. [ABSTRACT FROM AUTHOR]

Objective. In this retrospective study we report on the detection rate of prostate cancer (PCa) at different levels of prostate-specific antigen in serum (s-PSA) and at different PSA ratios (free:total PSA) during a 2-year period in patients without previously known PCa. Material and methods. During the years 2001 and 2002, 361 consecutive patients were examined with ultrasound-guided core needle biopsies at our department. The patients were biopsied due to an increased s-PSA level, a low PSA ratio or findings at digital rectal examination (DRE). Patients with previously known cancer (T1a/b or cancer already detected with fine-needle aspiration cytology) were excluded. We used the BioPince® biopsy needle, which has a stroke length of 32 mm. In 91% of the patients, eight biopsies were taken from the apex, mid-medial, mid-lateral and base positions bilaterally. Results. Of the 361 patients, 188 (52%) had PCa. Most cancers were T1c or T2 tumors (51% and 34%, respectively). Among patients with an s-PSA level of < 4 ng/ml, 8/35 (23%) had PCa. Five of 13 patients with a normal DRE (T1c) and an s-PSA level of < 4 ng/ml had PCa. In total, in the PSA ratio intervals 0.05-0.1 and 0.11-0.17, cancer was found in 71% and 51% of cases, respectively. In contrast, only 35% of patients had positive biopsies when the PSA ratio was normal (p<0.01). Conclusions. The overall cancer detection rate was high and a large proportion of patients with an s-PSA level of < 4 ng/ml had PCa. The risk of having PCa increased considerably with a low PSA ratio. [ABSTRACT FROM AUTHOR]