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The aim of this study is to investigate the incidental prostate cancer (iPCa) detection rates of different embedding methods in a large, contemporary cohort of patients with bladder outlet obstruction (BOO) treated with transurethral surgery. We relied on an institutional tertiary-care database to identify BOO patients who underwent either transurethral loop resection or laser (Holmium:yttrium–aluminium garnet) enucleation of the prostate (HoLEP) between 01/2012 and 12/2019. Embedding methods differed with regard to the extent of the additional prostate tissue submitted following the first ten cassettes of primary embedding (cohort A: one [additional] cassette/10 g residual tissue vs. cohort B: complete embedding of the residual tissue). Detection rates of iPCa among the different embedding methods were compared. Subsequently, subgroup analyses by embedding protocol were repeated in HoLEP-treated patients only. In the overall cohort, the iPCa detection rate was 11% (46/420). In cohort A (n = 299), tissue embedding resulted in a median of 8 cassettes/patient (range 1–38) vs. a median of 15 (range 2–74) in cohort B (n = 121) (p < .001). The iPCa detection rate was 8% (23/299) and 19% (23/121) in cohort A vs. cohort B, respectively (p < .001). Virtual reduction of the number of tissue cassettes to ten cassettes resulted in a iPCa detection rate of 96% in both cohorts, missing one stage T1a/ISUP grade 1 carcinoma. Increasing the number of cassettes by two and eight cassettes, respectively, resulted in a detection rate of 100% in both cohorts without revealing high-grade carcinomas. Subgroup analyses in HoLEP patients confirmed these findings, demonstrated by a 100 vs. 96% iPCa detection rate following examination of the first ten cassettes, missing one case of T1a/ISUP 1. Examination of 8 additional cassettes resulted in a 100% detection rate. The extent of embedding of material obtained from transurethral prostate resection correlates with the iPCa detection rate. However, the submission of 10 cassettes appears to be a reasonable threshold to reduce resource utilization while maintaining secure cancer detection.
The objective of the study was to test the impact of implementing standard full functional-length urethral sphincter (FFLU) and neurovascular bundle preservation (NVBP) with intraoperative frozen section technique (IFT) on long-term urinary continence in patients undergoing robotic-assisted radical prostatectomy (RARP). We relied on an institutional tertiary-care database to identify patients who underwent RARP between 01/2014 and 09/2019. Until 10/2017, FFLU was not performed and decision for NVBP was taken without IFT. From 11/2017, FFLU and IFT-guided NVBP was routinely performed in all patients undergoing RARP. Long-term continence (≥ 12 months) was defined as the usage of no or one safety- pad. Uni- and multivariable logistic regression models tested the correlation between surgical approach (standard vs FFLU + NVBP) and long-term continence. Covariates consisted of age, body mass index, prostate volume and extraprostatic extension of tumor. The study cohort consisted of 142 patients, with equally sized groups for standard vs FFLU + NVBP RARP (68 vs 74 patients). Routine FFLU + NVBP implementation resulted in a long-term continence rate of 91%, compared to 63% in standard RARP (p < 0.001). Following FFLU + NVBP RARP, 5% needed 1–2, 4% 3–5 pads/24 h and no patient (0%) suffered severe long-term incontinence (> 5 pads/24 h). No significant differences in patient or tumor characteristics were recorded between both groups. In multivariable logistic regression models, FFLU + NVBP was a robust predictor for continence (Odds ratio [OR]: 7.62; 95% CI 2.51–27.36; p < 0.001). Implementation of FFLU and NVBP in patients undergoing RARP results in improved long-term continence rates of 91%.
Localized prostate cancer exhibits multiple genomic alterations and heterogeneity at the proteomic level. Single-cell technologies capture important cell-to-cell variability responsible for heterogeneity in biomarker expression that may be overlooked when molecular alterations are based on bulk tissue samples. This study aims to identify prognostic biomarkers and describe the heterogeneity of prostate cancer and the associated microenvironment by simultaneously quantifying 36 proteins using single-cell mass cytometry analysis of over 1.6 million cells from 58 men with localized prostate cancer. We perform this task, using a high-dimensional clustering pipeline named Franken to describe subpopulations of immune, stromal, and prostate cells, including changes occurring in tumor tissues and high-grade disease that provide insights into the coordinated progression of prostate cancer. Our results further indicate that men with localized disease already harbor rare subpopulations that typically occur in castration-resistant and metastatic disease.
Background: To test the impact of urethral sphincter length (USL) and anatomic variants of prostatic apex (Lee-type classification) in preoperative multiparametric magnet resonance imaging (mpMRI) on mid-term continence in prostate cancer patients treated with radical prostatectomy (RP). Methods: We relied on an institutional tertiary-care database to identify patients who underwent RP between 03/2018 and 12/2019 with preoperative mpMRI and data available on mid-term (>6 months post-surgery) urinary continence, defined as usage 0/1 (-safety) pad/24 h. Univariable and multivariable logistic regression models were fitted to test for predictor status of USL and prostatic apex variants, defined in mpMRI measurements. Results: Of 68 eligible patients, rate of mid-term urinary continence was 81% (n = 55). Median coronal (15.1 vs. 12.5 mm) and sagittal (15.4 vs. 11.1 mm) USL were longer in patients reporting urinary continence in mid-term follow-up (both p < 0.01). No difference was recorded for prostatic apex variants distribution (Lee-type) between continent vs. incontinent patients (p = 0.4). In separate multivariable logistic regression models, coronal (odds ratio (OR): 1.35) and sagittal (OR: 1.67) USL, but not Lee-type, were independent predictors for mid-term continence. Conclusion: USL, but not apex anatomy, in preoperative mpMRI was associated with higher rates of urinary continence at mid-term follow-up.
The effect of race/ethnicity on cancer-specific mortality after salvage radical prostatectomy
(2022)
Background: To test the effect of race/ethnicity on cancer-specific mortality (CSM) after salvage radical prostatectomy (SRP).
Material and methods: We relied on the Surveillance, Epidemiology and End Results database (SEER, 2004–2016) to identify SRP patients of all race/ethnicity background. Univariate and multivariate Cox regression models addressed CSM according to race/ethnicity.
Results: Of 426 assessable SRP patients, Caucasians accounted for 299 (69.9%) vs. 68 (15.9%) African-Americans vs. 39 (9.1%) Hispanics vs. 20 (4.7%) Asians. At diagnosis, African-Americans (64 years) were younger than Caucasians (66 years), but not younger than Hispanics (66 years) and Asians (67 years). PSA at diagnosis was significantly higher in African-Americans (13.2 ng/ml), Hispanics (13.0 ng/ml), and Asians (12.2 ng/ml) than in Caucasians (7.8 ng/ml, p = 0.01). Moreover, the distribution of African-Americans (10.3%–36.6%) and Hispanics (0%–15.8%) varied according to SEER region. The 10-year CSM was 46.5% in African-Americans vs. 22.4% in Caucasians vs. 15.4% in Hispanics vs. 15.0% in Asians. After multivariate adjustment (for age, clinical T stage, lymph node dissection status), African-American race/ethnicity was an independent predictor of higher CSM (HR: 2.2, p < 0.01), but not Hispanic or Asian race/ethnicity. The independent effect of African-American race/ethnicity did not persist after further adjustment for PSA.
Conclusion: African-Americans treated with SRP are at higher risk of CSM than other racial/ethnic groups and also exhibited the highest baseline PSA. The independent effect of African-American race/ethnicity on higher CSM no longer applies after PSA adjustment since higher PSA represents a distinguishing feature in African-American patients.
Background: We aimed to determine the concordance between the radiologic stage (rT), using multiparametric magnetic resonance imaging (mpMRI), and pathologic stage (pT) in patients with high-risk prostate cancer and its influence on nerve-sparing surgery compared to the use of the intraoperative frozen section technique (IFST). Methods: The concordance between rT and pT and the rates of nerve-sparing surgery and positive surgical margin were assessed for patients with high-risk prostate cancer who underwent radical prostatectomy. Results: The concordance between the rT and pT stages was shown in 66.4% (n = 77) of patients with clinical high-risk prostate cancer. The detection of patients with extraprostatic disease (≥pT3) by preoperative mpMRI showed a sensitivity, negative predictive value and accuracy of 65.1%, 51.7% and 67.5%. In addition to the suspicion of extraprostatic disease in mpMRI (≥rT3), 84.5% (n = 56) of patients with ≥rT3 underwent primary nerve-sparing surgery with IFST, resulting in 94.7% (n = 54) of men with at least unilateral nerve-sparing surgery after secondary resection with a positive surgical margin rate related to an IFST of 1.8% (n = 1). Conclusion: Patients with rT3 should not be immediately excluded from nerve-sparing surgery, as by using IFST some of these patients can safely undergo nerve-sparing surgery.
Annihilation dynamics plays a fundamental role in the baryon–antibaryon interaction (B–B) at lowenergy and its strength and range are crucial in the assessment of possible baryonic bound states. Experimental data on annihilation cross sections are available for the p–p system but not in the low relative momentum region. Data regarding the B–B interaction with strange degrees of freedom are extremely scarce, hence the modeling of the annihilation contributions is mainly based on nucleon–antinucleon (N–N) results, when available. In this letter we present a measurement of the p–p, p–⊕p– and – interaction using correlation functions in the relative momentum space in high-multiplicity triggered pp collisions at √s = 13 TeV recorded by ALICE at the LHC. In the p–p system the couplings to the mesonic channels in different partial waves are extracted by adopting a coupled-channel approach with recent χEFT potentials. The inclusion of these inelastic channels provides good agreement with the data, showing a significant presence of the annihilation term down to zero momentum. Predictions obtained using the Lednický–Lyuboshits formula and scattering parameters obtained from heavy-ion collisions, hence mainly sensitive to elastic processes, are compared with the experimental p–⊕p– and – correlations. The model describes the – data and underestimates the p–⊕p– data in the region of momenta below 200 MeV/c. The observed deviation indicates a different contribution of annihilation channels to the two systems containing strange hadrons.
The first results on K∗(892)± resonance production in inelastic pp collisions at LHC energies of √s = 5.02, 8, and 13 TeV are presented. The K∗(892)± has been reconstructed via its hadronic decay channel K∗(892)± → K0 S + π± with the ALICE detector. Measurements of transverse momentum distributions, pT-integrated yields, and mean transverse momenta for charged K∗(892) are found to be consistent with previous ALICE measurements for neutral K∗(892) within uncertainties. For pT > 1 GeV/c the K∗(892)± transverse momentum spectra become harder with increasing centre-of-mass energy from 5.02 to 13 TeV, similar to what previously observed for charged kaons and pions. For pT < 1 GeV/c the K∗(892)± yield does not evolve significantly and the abundance of K∗(892)± relative to K is rather independent of the collision energy. The transverse momentum spectra, measured for K∗(892)± at midrapidity in the interval 0 < pT < 15 GeV/c, are not well described by predictions of different versions of PYTHIA 6, PYTHIA 8 and EPOS-LHC event generators. These generators reproduce the measured pTintegrated K∗±/K ratios and describe well the momentum dependence for pT < 2 GeV/c.
Inclusive, prompt and non-prompt J/ψ production at midrapidity in p-Pb collisions at √sNN = 5.02 TeV
(2022)
A measurement of inclusive, prompt, and non-prompt J/ψ production in p-Pb collisions at a nucleon-nucleon centre-of-mass energy sNN−−−√ = 5.02 TeV is presented. The inclusive J/ψ mesons are reconstructed in the dielectron decay channel at midrapidity down to a transverse momentum pT = 0. The inclusive J/ψ nuclear modification factor RpPb is calculated by comparing the new results in p-Pb collisions to a recently measured proton-proton reference at the same centre-of-mass energy. Non-prompt J/ψ mesons, which originate from the decay of beauty hadrons, are separated from promptly produced J/ψ on a statistical basis for pT larger than 1.0 GeV/c. These results are based on the data sample collected by the ALICE detector during the 2016 LHC p-Pb run, corresponding to an integrated luminosity Lint = 292 ± 11 μb−1, which is six times larger than the previous publications. The total uncertainty on the pT-integrated inclusive J/ψ and non-prompt J/ψ cross section are reduced by a factor 1.7 and 2.2, respectively. The measured cross sections and RpPb are compared with theoretical models that include various combinations of cold nuclear matter effects. From the non-prompt J/ψ production cross section, the bb¯¯¯ production cross section at midrapidity, dσbb¯¯¯/dy, and the total cross section extrapolated over full phase space, σbb¯¯¯, are derived.
Neutral pion (π0) and η meson production cross sections were measured up to unprecedentedly high transverse momenta (pT) in p–Pb collisions at √sNN = 8.16 TeV. The mesons were reconstructed via their two-photon decay channel in the rapidity interval −1.3 < y < 0.3 in the ranges of 0.4 < pT < 200 GeV/c and 1.0 < pT < 50 GeV/c, respectively. The respective nuclear modification factor (RpPb) is presented for pT up to of 200 and 30 GeV/c, where the former was achieved by extending the π0 measurement in pp collisions at √s = 8 TeV using the merged cluster technique. The values of RpPb are below unity for pT < 10 GeV/c, while they are consistent with unity for pT > 10 GeV/c, leaving essentially no room for final state energy loss. The new data provide strong constraints for nuclear parton distribution and fragmentation functions over a broad kinematic range and are compared to model predictions as well as previous results at √sNN = 5.02 TeV.