Materiały źródłowe

• #1 Prostatitis: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/785418-overview

  The prognosis in patients with the first occurrence of acute bacterial prostatitis is good with aggressive antibiotic therapy and good patient compliance. Lack of treatment with antibiotics increases risk for impaired fertility, epididymitis, chronic prostatitis, and prostatic abscess formation. […] In patients with chronic prostatitis with acute exacerbations, causative underlying factors may affect overall prognosis. Prostatitis may lead to urosepsis with significant associated mortality in patients with diabetes mellitus, patients on dialysis for chronic renal failure, patients who are immunocompromised, and postsurgical patients who have had urethral instrumentation. […] Chronic prostatitis and asymptomatic inflammatory prostatitis have not been definitively linked to the development of prostate cancer.

• #2 Prostatitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15319-prostatitis

  While it can cause unpleasant symptoms, the good news about prostatitis is that you usually feel relief with the right treatment. […] Antibiotics treat most cases of bacterial prostatitis. While more challenging to treat, most people with CPPS feel better after receiving treatment for their symptoms using the UPOINT system. If you don’t feel relief with treatment, work with your provider until you do. They can make sure prostatitis doesn’t affect your quality of life.

• #3 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  A 2014 study of patients with acute bacterial prostatitis identified age older than 65 years, body temperature greater than 100.4F (38C), benign prostatic hypertrophy, urinary retention, and transurethral catheterization as factors associated with poor outcomes. These outcomes included septic shock, positive blood culture, and prostatic abscess. In patients with any of these factors, the physician should strongly consider ordering a complete blood count and a basic metabolic panel. In the same study, a white blood cell count greater than 18,000 per mm3 (18 109 per L) and a blood urea nitrogen level greater than 19 mg per dL (6.8 mmol per L) were independently associated with severe cases of acute bacterial prostatitis. Inflammatory markers, such as C-reactive protein and erythrocyte sedimentation rate, will likely be elevated, but these tests have minimal clinical or diagnostic utility.

• #4 Acute Bacterial Prostatitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2002872-overview

  If the initial response to medical therapy for acute bacterial prostatitis is favorable, the patient’s prognosis is very good. […] Decreased fertility has been reported, but only in cases of massive bacterial inoculation. […] Prostatic abscess is an uncommon but well-described complication of acute bacterial prostatitis. […] Other potential sequelae of acute bacterial prostatitis include progression to chronic prostatitis, septicemia, pyelonephritis, and epididymitis. Nearly 10% of patients with acute bacterial prostatitis develop chronic prostatitis and another 10% develop chronic pelvic pain syndrome.

• #5 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Approximately 13% of patients with acute bacterial prostatitis experience recurrence necessitating a longer course of antibiotics. Patients with persistent or recurrent symptoms should have a repeat urine culture to evaluate for repeat bacterial prostatitis and be treated based on culture results. After three months of persistent or recurrent symptoms, patients should be evaluated and treated based on chronic prostate syndrome guidelines. Approximately one in nine patients with acute bacterial prostatitis will develop chronic bacterial prostatitis or chronic pelvic pain syndrome.

• #6 The Lifetime Risk and Prognosis of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in the Middle-Aged Chinese Males

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6637838/

  A better SRR was observed in patients with a history of smoking compared to those with no history of smoking (p .01). A better SRR was also observed in the treatment groups in patients who had not had comorbidities of diabetes and/or BPH compared to those with the comorbidities. […] It has been reported that 35% to 50% of the male population is likely to be affected by symptoms associated with CPPS during their lifetime. […] This nationwide survey data from 1,091 patients with CPPS from 4,315 valid questionnaires identify that the lifetime risk of CPPS occurrence is about 25% in Chinese males over 40 years old. A good prognosis could be achieved without treatment for some cases of CPPS, while others required a timely symptom-orientated treatment using adequate medications combined with lifestyle adjustment and follow-up. Lifestyle adjustment, especially less sedentary work and lower alcohol consumption, could play an important role in symptom relief in patients with CPPS, whether or not they receive treatment.

• #7 The Lifetime Risk and Prognosis of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in the Middle-Aged Chinese Males

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6637838/

  Knowledge is limited about the lifetime risk of chronic pelvic pain syndrome (CPPS) occurrence in Chinese middle-aged males and the prognosis of CPPS patients with and without treatment. […] Regardless of whether patients had received medical treatment, engagement in sedentary work and regular alcohol consumption had a significant negative influence, while marriage had a positive influence, on the prognosis of CPPS. A good prognosis could be achieved without treatment for some cases of CPPS, while others required a timely symptom-orientated treatment using adequate medications combined with lifestyle adjustment and follow-up. […] The results from this study will further the understanding of the relationship between the prognosis of CPPS and medical treatments, and help to develop a new module for clinical management of patients with CPPS.

• #8 Inflammation-related indicators have a potential to increase overall quality of the prostate cancer management: a narrative review – Zhou – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/113447/html

  Inflammation-related indicators based on haematological tests have some diagnostic and prognostic value not only when used alone but also in combination with common clinical indicators such as prostate-specific antigen (PSA), and can significantly improve the accuracy of diagnostic results. […] Preoperative NLR levels in localized PCa patients affect their overall survival (OS), cancer-specific survival (CSS), and biochemical recurrence-free survival (BCRFS) after radical prostatectomy (RP). […] In patients with castration-resistant prostate cancer (CRPC), a high NLR is associated with poorer OS, progression-free survival (PFS), CSS, and radiographic PFS. […] Elevated C-reactive protein (CRP) levels are an independent predictor of poorer OS in metastatic PCa. […] The value of inflammation-related indicators in predicting the diagnosis and prognosis of PCa patients is now becoming clear.

• #9

  https://link.springer.com/article/10.1007/s00345-024-04991-6

  mpMRI is routinely used to stratify the risk of clinically significant prostate cancer (csPCa) in men with elevated PSA values before biopsy. […] mpMRI findings are the dominant predictor for csPCa on follow-up prostate biopsy. However, PSA density, age, and prior negative biopsy history are independent predictors. They must be considered when discussing the individual risk for csPCa following suspicious mpMRI and may help facilitate the further diagnostical approach. […] In conclusion, PI-RADS is the dominant predictor for csPCa on follow-up prostate biopsy. However, PSA density, age, and prior negative biopsy history contribute independent predictive value and must be considered when discussing the individual risk for csPCa following mpMRI. These factors should be considered, especially in men with a PI-RADS 3 lesion, to facilitate decision-making regarding further invasive diagnostic evaluation. In men with a PI-RADS 4 or 5 lesion, predicting the risk for csPCa before biopsy more accurately might help prepare for the biopsy outcome and can be helpful when considering the biopsy strategy.

• #10 Predicting Prostate Biopsy Outcomes: A Preliminary Investigation on Screening with Ultrahigh B-Value Diffusion-Weighted Imaging as an Innovative Diagnostic Biomarker | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0151176

  DW-MRI with a b-value of 3000 s/mm2 was found to be the most accurate and reliable MRI modality for PCa tumor detection and localization, particularly for TZ lesion discrimination. […] It may be stated that the b-value of 3000 s/mm2 is a novel, improved diagnostic biomarker with greater predictive accuracy for PCa prior to biopsy. […] The ultrahigh b-value DW-MRI showed outstanding diagnostic performance in the sub-group, with the 3000 s/mm2 DW-MRI alone outdoing both T2WI and conventional DW-MRI, thus implying that the ultrahigh b-value DW-MRI alone could serve as a promising biomarker for guiding the prostate biopsy decision. […] Predictive values were significantly higher for both the PZ and TZ. Ultrahigh b-value DW-MRI was identified as a vital and independent predictor of PCa at the stage of prostate biopsy. […] These results suggest that ultrahigh b-value DW-MRI, based on PI-RADS, helps radiologists and urologists to reach consensus on clinical decision making for prostate biopsy.

• #11 The value of apparent diffusion coefficient values in predicting Gleason grading of low to intermediate-risk prostate cancer | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-024-01684-x

  ADC values demonstrate an inverse relationship with the invasiveness of PCa, indicating that higher invasiveness is associated with lower ADC values. […] ADC values play a crucial role in the accurate preoperative evaluation of low to intermediate-risk PCa, thus aiding clinicians in developing tailored treatment plans. […] The Spearman rank correlation analysis yields significant findings, demonstrating a negative correlation between PCa ADCmin and GS, as well as between ADCmean and GS. Notably, with escalating GSs, there is a consistent and discernible decline in ADC values. […] This study demonstrates that ADC values can effectively differentiate between different invasive lesions, which is beneficial for the preoperative evaluation of PCa. […] The inverse correlation observed between GS values and ADCmin/ADCmean substantiates the assertion that as the malignancy of prostate lesions intensifies, ADC values correspondingly decline, potentially portending an unfavorable PCa prognosis.

• #12 Prostate Cancer Nomograms | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/nomograms/prostate

  Our pre-radical prostatectomy nomogram predicts the extent of the cancer and long-term results following radical prostatectomy (surgery to remove the prostate gland and surrounding lymph nodes). […] Our post-radical prostatectomy nomogram predicts the probability of remaining cancer recurrence-free at two, five, seven, and ten years following surgery. […] Our salvage radiation therapy nomogram predicts whether a recurrence of prostate cancer after radical prostatectomy can be treated successfully with salvage radiation therapy (external-beam radiation given after the prostate cancer returns). […] This nomogram can be used by patients to estimate the risk of dying of prostate cancer if their cancer recurs, signaled by a rising PSA, after radical prostatectomy. The nomogram predicts the likelihood, in a man initially treated with surgery, that he will die of prostate cancer five, ten, and 15 years from the time his PSA begins to rise. […] Our Male Life Expectancy tool can be used by patients before treatment for prostate cancer.

• #13 Improving Prediction of Prostate Cancer Recurrence using Chemical Imaging | Scientific Reports

  https://www.nature.com/articles/srep08758

  Precise Outcome prediction is crucial to providing optimal cancer care across the spectrum of solid cancers. […] Here, we report an approach to predict the risk of prostate cancer recurrence, at the time of initial diagnosis, using a combination of emerging chemical imaging, a diagnostic protocol that focuses simultaneously on the tumor and its microenvironment and data analysis of frequent patterns in molecular expression. […] Our approach outperforms the two widely used tools, Kattan nomogram and CAPRA-S score in a head-to-head comparison for predicting risk of recurrence. […] Importantly, the approach provides a histologic basis to the prediction that identifies chemical and morphologic features in the tumor microenvironment that is independent of conventional clinical information, opening the door to similar advances in other solid tumors.

• #14 The role of the maximum involvement of biopsy core in predicting outcome for patients treated with dose-escalated radiation therapy for prostate cancer | Radiation Oncology | Full Text

  https://ro-journal.biomedcentral.com/articles/10.1186/1748-717X-7-127

  To evaluate the influence of the maximum involvement of biopsy core (MIBC) on outcome for prostate cancer patients treated with dose-escalated external beam radiotherapy (EBRT). […] MIBC was prognostic for all endpoints except OS; with greatest impact in those with Gleason scores of 810. However, on multivariate analysis, MIBC was only prognostic for FFBF (hazard ratio [HR] 1.9, p=0.008), but not for FFM (p=0.19), CSS (p=0.16), and OS (p=0.99). […] In patients undergoing dose-escalated EBRT, MIBC had the greatest influence in those with Gleason scores of 810 but provided no additional prognostic data as compared to PPC and PCV, which remain the preferable prognostic variables in this patient population. […] MIBC demonstrated significant correlation with FFBF (p=0.0001), FFM (p=0.005), and CSS (p=0.007) and borderline association with OS (p=0.06).

• #15 ExoDx prostate test as a predictor of outcomes of high-grade prostate cancer – an interim analysis | Prostate Cancer and Prostatic Diseases

  https://www.nature.com/articles/s41391-023-00675-1

  Patient outcomes were assessed based on a pre-biopsy ExoDx Prostate (EPI) score at 2.5 years of the 5-year follow-up of ongoing prostate biopsy Decision Impact Trial of the ExoDx Prostate (IntelliScore). […] This follow-up analysis captures subsequent biopsy outcomes and demonstrates that men receiving EPI low-risk scores (15.6) significantly defer the time to first biopsy and remain at a very low pathologic risk by 2.5-years after the initial study. […] In the EPI arm, low-risk patients were much less likely to have biopsies than high-risk patients (44.6% vs 79.0%, p0.001), whereas in the SOC arm, the choice to defer was independent of EPI and therefore, not different between low-risk and high-risk EPI scores (59.6% vs 58.8%, p=0.99). […] Patients with low-risk EPI scores (15.6) followed for 2.5 years from either arm had a low rate (7.9%, 14/177) of high-grade prostate cancer (GG2) detected upon biopsy. […] Overall, this study demonstrates that a pre-biopsy EPI test leads to better outcomes even when followed for 2.5 years after the initial biopsy decision-making process.

• #16 Inflammation-related indicators have a potential to increase overall quality of the prostate cancer management: a narrative review – Zhou – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/113447/html

  The NLR have a significant predictive value towards the development of metastases PCa. […] The PLR appears to have the greatest accuracy in predicting an initial diagnosis of clinically significant PCa. […] The PLR also has the potential to predict the Gleason score. […] A clinical study showed that pre-prostate biopsy PLR was not an independent predictor of csPCa. […] The predictive value of the above inflammation-related indicators for the diagnosis and prognosis of PCa has been widely studied but has not yet been applied in clinical practice. […] Therefore, there is a need to find more meaningful predictors or develop comprehensive predictive models to further guide diagnosis and treatment after screening and to predict the prognosis of patients.

• #17 Acute Bacterial Prostatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

  Prostate-specific antigen (PSA) levels are not indicated in the workup of acute bacterial prostatitis. Approximately 70% of men will have a spurious PSA elevation due to disruption of prostatic architecture caused by inflammation. Elevated PSA levels can persist for one to two months after treatment. If PSA levels remain elevated for more than two months, prostate cancer should be considered because 20% of persistent elevations are associated with malignancy. […] Imaging studies are usually unnecessary during the initial evaluation, but may help when the diagnosis remains unclear or when patients do not respond to adequate antibiotic therapy. Patients who remain febrile after 36 hours or whose symptoms do not improve with antibiotics should undergo transrectal ultrasonography to evaluate for prostatic abscess. Alternatively, noncontrast computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvis could be considered. Prostate biopsy should not be performed to avoid inducing septicemia.

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