Morphologic spectrum of treatment-related changes in prostate tissue and prostate cancer: An Updated Review

Real-world analysis of leuprorelin acetate microspheres-based neoadjuvant therapy for patients with high-risk prostate cancer

Objective

Boennuokang® leuprorelin acetate microspheres show a certain efficacy in patients with prostate cancer, but its utilization as neoadjuvant therapy in patients with high-risk prostate cancer remains unclear. Hence, this real-world study investigated the efficacy and safety of Boennuokang® leuprorelin acetate microspheres-based treatment as neoadjuvant therapy in patients with high-risk prostate cancer.

Methods

This retrospective study included 53 patients with high-risk prostate cancer who received Boennuokang® leuprorelin acetate microspheres as neoadjuvant therapy and laparoscopic radical prostatectomy.

Results

The median prostate-specific antigen (PSA) was 34.1 ng/mL before neoadjuvant therapy and reduced to 0.8 ng/mL after neoadjuvant therapy (P<0.001). Testosterone showed a decreased tendency after neoadjuvant therapy, but without statistical significance (P=0.185). After surgery, 36 (67.9%) patients had negative surgical margin. The median (interquartile range) prostate volume reduced from 40.5 (33.4-55.2) mL before neoadjuvant therapy to 30.2 (25.2-40.2) mL after neoadjuvant therapy (P<0.001). Meanwhile, alkaline phosphatase before neoadjuvant therapy, at one month (M1), 3 months (M3), 6 months (M6), and 12 months (M12) after surgery tended to be increased (P=0.029), but this increment lacks clinical significance, while the glomerular filtration rate (P=0.441) and albumin (P=0.548) did not vary among different time points. Erectile dysfunction and loss of libido was the most common adverse event, with incidences of 84.9% during neoadjuvant therapy, 79.2% at M1, 71.7% at M3, 67.9% at M6, and 56.6% at M12.

Conclusion

Boennuokang® leuprorelin acetate microspheres-based treatment as neoadjuvant therapy decreases PSA, testosterone, and prostate volume, with acceptable positive surgical margin rate in patients with high-risk prostate cancer and its safety profiles should be validated.

Multi-branch CNNFormer: a novel framework for predicting prostate cancer response to hormonal therapy

PURPOSE

This study aims to accurately predict the effects of hormonal therapy on prostate cancer (PC) lesions by integrating multi-modality magnetic resonance imaging (MRI) and the clinical marker prostate-specific antigen (PSA). It addresses the limitations of Convolutional Neural Networks (CNNs) in capturing long-range spatial relations and the Vision Transformer (ViT)'s deficiency in localization information due to consecutive downsampling. The research question focuses on improving PC response prediction accuracy by combining both approaches.

METHODS

We propose a 3D multi-branch CNN Transformer (CNNFormer) model, integrating 3D CNN and 3D ViT. Each branch of the model utilizes a 3D CNN to encode volumetric images into high-level feature representations, preserving detailed localization, while the 3D ViT extracts global salient features. The framework was evaluated on a 39-individual patient cohort, stratified by PSA biomarker status.

RESULTS

Our framework achieved remarkable performance in differentiating responders and non-responders to hormonal therapy, with an accuracy of 97.50%, sensitivity of 100%, and specificity of 95.83%. These results demonstrate the effectiveness of the CNNFormer model, despite the cohort's small size.

CONCLUSION

The findings emphasize the framework's potential in enhancing personalized PC treatment planning and monitoring. By combining the strengths of CNN and ViT, the proposed approach offers robust, accurate prediction of PC response to hormonal therapy, with implications for improving clinical decision-making.

Potential Benefits of Green Tea in Prostate Cancer Prevention and Treatment: A Comprehensive Review

Prostate cancer is a prevalent and debilitating disease that necessitates effective prevention and treatment strategies. Green tea, a well-known beverage derived from the Camellia sinensis plant, contains bioactive compounds with potential health benefits, including catechins and polyphenols. This comprehensive review aims to explore the potential benefits of green tea in prostate cancer prevention and treatment by examining existing literature. Green tea possesses antioxidant, anti-inflammatory, and anti-carcinogenic properties attributed to its catechins, particularly epigallocatechin gallate. Epidemiological studies have reported an inverse association between green tea consumption and prostate cancer risk, with potential protection against aggressive forms of the disease. Laboratory studies demonstrate that green tea components inhibit tumor growth, induce apoptosis, and modulate signaling pathways critical to prostate cancer development and progression. Clinical trials and human studies further support the potential benefits of green tea. Green tea consumption has been found to be associated with a reduction in prostate-specific antigen levels, tumor markers, and played a potential role in slowing disease progression. However, challenges remain, including optimal dosage determination, formulation standardization, and conducting large-scale, long-term clinical trials. The review suggests future research should focus on combinatorial approaches with conventional therapies and personalized medicine strategies to identify patient subgroups most likely to benefit from green tea interventions.

French AFU Cancer Committee Guidelines - Update 2024-2026: Prostate cancer - Diagnosis and management of localised disease

OBJECTIVE

The aim of the Oncology Committee of the French Urology Association is to propose updated recommendations for the diagnosis and management of localized prostate cancer (PCa).

METHODS

A systematic review of the literature from 2022 to 2024 was conducted by the CCAFU on the elements of diagnosis and therapeutic management of localized PCa, evaluating references with their level of evidence.

RESULTS

The recommendations set out the genetics, epidemiology and diagnostic methods of PCa, as well as the concepts of screening and early detection. MRI, the reference imaging test for localized cancer, is recommended before prostate biopsies are performed. Molecular imaging is an option for disease staging. Performing biopsies via the transperineal route reduces the risk of infection. Active surveillance is the standard treatment for tumours with a low risk of progression. Therapeutic methods are described in detail, and recommended according to the clinical situation.

CONCLUSION

This update of French recommendations should help to improve the management of localized PCa.

Administering [177Lu]Lu-PSMA-617 Prior to Radical Prostatectomy in Men with High-risk Localised Prostate Cancer (LuTectomy): A Single-centre, Single-arm, Phase 1/2 Study

BACKGROUND

High-risk localised prostate cancer (HRCaP) has high rates of biochemical recurrence; [177Lu]Lu-PSMA-617 is effective in men with advanced prostate cancer.

OBJECTIVE

To investigate the dosimetry, safety, and efficacy of upfront [177Lu]Lu-PSMA-617 in men with HRCaP prior to robotic radical prostatectomy (RP).

DESIGN, SETTING, AND PARTICIPANTS

In this single-arm, phase I/II trial, we recruited men with HRCaP (any of prostate-specific antigen [PSA] >20 ng/ml, International Society of Urological Pathology (ISUP) grade group [GG] 3-5, and ≥cT2c), with high tumour uptake on [68Ga]Ga-PSMA-11 positron emission tomography/computed tomography (PSMA PET/CT), and scheduled for RP.

INTERVENTION

Cohort A (n = 10) received one cycle and cohort B (n = 10) received two cycles of [177Lu]Lu-PSMA-617 (5 GBq) followed by surgery 6 weeks later.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The primary endpoint was tumour radiation absorbed dose. Adverse events (AEs; Common Terminology Criteria for Adverse Events (CTCAE) version 5.0), surgical safety (Clavien-Dindo), imaging, and biochemical responses were evaluated (ClinicalTrials.gov: NCT04430192).

RESULTS AND LIMITATIONS

Between May 29, 2020 and April 28, 2022, 20 patients were enrolled. The median PSA was 18 ng/ml (interquartile range [IQR] 11-35), Eighteen (90%) had GG ≥3, and six (30%) had N1 disease. The median (IQR) highest tumour radiation absorbed dose after cycle 1 for all lesions was 35.5 Gy (19.5-50.1), with 19.6 Gy (11.3-48.4) delivered to the prostate. Five patients received radiation to lymph nodes. Nine (45%) patients achieved >50% PSA decline. The most common AEs related to [177Lu]Lu-PSMA-617 were grade 1 fatigue in eight (40%), nausea in seven (35%), dry mouth in six (30%), and thrombocytopenia in four (20%) patients. No grade 3/4 toxicities or Clavien 3-5 complications occurred. Limitations include small a sample size.

CONCLUSIONS

In men with HRCaP and high prostate-specific membrane antigen (PSMA) expression, [177Lu]Lu-PSMA-617 delivered high levels of targeted radiation doses with few toxicities and without compromising surgical safety. Further studies of [177Lu]Lu-PSMA-617 in this population are worthwhile to determine whether meaningful long-term oncological benefits can be demonstrated.

PATIENT SUMMARY

In this study, we demonstrate that up to two cycles of [177Lu]Lu-PSMA-617 given prior to radical prostatectomy in patients with high-risk localised prostate cancer are safe and deliver targeted doses of radiation to tumour-affected tissues. It is tolerated well with minimal treatment-related adverse events, and surgery is safe with a low rate of complications. Activity measured through PSA reduction, repeat PSMA PET/CT, and histological response is promising.