Carcinome intracanalaire de la prostate

Arch Ital Urol Androl. 2026 Aug 28:15720. doi: 10.4081/aiua.2026.15720. Online ahead of print.ABSTRACTOBJECTIVE: To compare the diagnostic accuracy of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and multiparametric magnetic resonance imaging (mpMRI) for the detection of histologically confirmed pelvic lymph node metastases in patients with intermediate- and high-risk prostate cancer.METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were searched from January 2011 to March 2026. Studies evaluating PSMA PET/CT and/or mpMRI for preoperative pelvic lymph node staging using histopathology as the reference standard were included. Study quality was assessed using the Quality Assessment of Diagnostic Performance Studies-2 tool (QUADAS-2). Pooled sensitivity and specificity were estimated using a hierarchical bivariate random- effects (Reitsma) model, and hierarchical summary receiver operating characteristic (HSROC) curves were generated.RESULTS: Sixteen studies comprising 1,999 patients met the inclusion criteria. Fourteen studies contributed to the PSMA PET/CT analysis and six studies to the mpMRI analysis. For PSMA PET/CT, pooled sensitivity was 54.6% (95% CI 43.7-65.1%) and pooled specificity was 92.7% (95% CI 90.5-94.4%). The HSROC area under the curve (AUC) was 0.909. For mpMRI, pooled sensitivity was 33.0% (95% CI 18.7-51.3%) and pooled specificity was 94.9% (95% CI 92.2-96.8%), with an HSROC AUC of 0.941. Indirect comparison of pooled estimates suggested that PSMA PET/CT had higher sensitivity and a higher diagnostic odds ratio than mpMRI. However, because these estimates were derived from separate bodies of evidence rather than direct head-to-head comparative studies, this comparison should be interpreted with caution.CONCLUSIONS: PSMA PET/CT demonstrated higher pooled sensitivity than mpMRI while maintaining similarly high specificity for detecting pelvic lymph node metastases. However, the moderate sensitivity of both imaging modalities indicates that a negative PSMA PET/CT scan cannot reliably exclude microscopic nodal disease. Furthermore, this comparison between pooled estimates should be interpreted with caution because it is based on an indirect comparison rather than a formal head-to-head meta-analysis. Consequently, extended pelvic lymph node dissection remains the reference standard for pathological nodal staging in appropriately selected patients, and prospective head-to-head comparative studies are required to define the relative diagnostic performance of PSMA PET/CT and mpMRI.PMID:42663310 | DOI:10.4081/aiua.2026.15720

World J Urol. 2026 Aug 22;44(1):596. doi: 10.1007/s00345-026-06686-6.ABSTRACTPURPOSE: Prostatic ductal adenocarcinoma (PDA) is a rare, aggressive prostate cancer subtype associated with advanced disease and poorer prognosis than acinar adenocarcinoma. Small ductal components influence management and preclude active surveillance. This study analyzed oncologic outcomes and therapeutic patterns in a multicenter German cohort.METHODS: Retrospective multicenter cohort, seven high-volume German centers. 82 patients with histologically confirmed PDA diagnosed 2014-2024 included. Histopathological data from biopsy and radical prostatectomy (RP) specimens.CLINICAL DATA: local/systemic treatments, follow-up until 2025.PRIMARY OUTCOME: time to systemic therapy. Secondary: overall survival. Predictors of adverse outcomes assessed via Cox regression.RESULTS: Most patients presented with d'Amico high-risk (47/82, 57.3%) or intermediate-risk (28/82, 34.2%) disease; 9.8% (8/82) had synchronous metastases. RP performed in 82.9% (68/82), radiotherapy in 7.3% (6/82). Postoperative lymph node positivity and positive surgical margins occurred in 25.0% (17/68) and 22.1% (15/68), respectively. Median follow-up was 36 months (IQR 20-54 months). At the time of analysis, overall survival and cancer-specific survival were immature, with a limited number of events during follow-up. Among patients who required systemic therapy during follow-up, the median interval from local treatment to initiation of systemic therapy was 23 months (IQR 5-31 months). High pre-/postoperative Gleason scores (≥ 8) were associated with earlier initiation of systemic therapy. Among patients receiving systemic treatment (n = 24), ADT monotherapy showed longer median duration (27.2 months) than ARPI (10.9 months) or chemotherapy (6.1 months).LIMITATIONS: retrospective design, limited sample size.CONCLUSION: PDA demonstrates aggressive behavior with early need for systemic therapeutic escalation in a substantial proportion. High Gleason scores were associated with earlier initiation of systemic therapy. These findings suggest that PDA should be considered a high-risk entity. However, survival outcomes require longer follow-up for definitive conclusions.PMID:42631874 | DOI:10.1007/s00345-026-06686-6

Oxf Med Case Reports. 2026 Aug 12;2026(8):omag156. doi: 10.1093/omcr/omag156. eCollection 2026 Aug.ABSTRACTPrimary small cell neuroendocrine carcinoma (SCNC) of the bladder is an exceptionally aggressive malignancy. We report the case of an 80-year-old male, a chronic smoker, presenting with an 8-month history of intermittent total hematuria. Cystoscopy revealed a 72 mm mass infiltrating the bladder dome, posterior, and lateral walls. Histopathological analysis of transurethral resection specimens demonstrated a necrotic diffuse proliferation of monomorphic small cells infiltrating the muscularis propria. Immunohistochemistry showed positivity for synaptophysin, chromogranin A, CD56, and TTF1, whereas GATA3 and p63 were negative. The Ki-67 index exceeded 90%. Systemic staging (cT3bN0M0) confirmed the primary bladder origin. Although multimodal management, including neoadjuvant chemotherapy and radical cystoprostatectomy, was recommended, the patient-initiated chemotherapy but declined surgery. Primary bladder SCNC is a highly invasive entity requiring early diagnosis and multidisciplinary care. The diagnosis is strictly anatomopathological. Differentiating this entity from primary pulmonary small cell carcinoma is a critical challenge, making systemic radiological staging mandatory.PMID:42592056 | PMC:PMC13463626 | DOI:10.1093/omcr/omag156

Eur Urol Focus. 2026 Aug 12:S2405-4569(26)00122-7. doi: 10.1016/j.euf.2026.06.026. Online ahead of print.ABSTRACTBACKGROUND AND OBJECTIVE: Pure urothelial carcinoma (UC) and histological subtypes (HS) in bladder cancer (BC) are associated with distinct pathological features and oncologic outcomes across disease stages. Circulating tumor DNA (ctDNA) is a promising perioperative biomarker, but its prognostic performance across histologic subtypes remains unclear. We evaluated the prognostic value of perioperative tumor-informed ctDNA in patients with pure UC and HS.METHODS: We analyzed a database of consecutive patients with BC who underwent radical cystectomy with available preoperative or postoperative ctDNA between 2021 and 2025. Patients were stratified into four groups according to histology status and ctDNA detectability at both preoperative and postoperative time points. Disease-free survival (DFS) was estimated using the Kaplan-Meier method and compared with log-rank tests. Associations between groups and DFS were evaluated using uni- and multivariable Cox regression analyses.KEY FINDINGS AND LIMITATIONS: Among 138 patients with preoperative ctDNA, negative ctDNA status was associated with significantly higher 24-mo DFS compared with positive ctDNA in both pure UC (89% vs 49%, p < 0.001) and HS (79% vs 43%, p = 0.012). Multivariable Cox regression confirmed positive preoperative ctDNA as an independent predictor of recurrence or death in pure UC (hazard ratio [HR] = 4.07, 95% confidence interval [CI] = 1.29-12.81, p = 0.020) and HS groups (HR = 3.99, 95% CI = 1.24-12.82, p = 0.023). Similarly, among 144 patients with postoperative ctDNA, negative ctDNA status predicted higher 24-mo DFS in pure UC (81% vs 30%, p < 0.001) and HS (66% vs 29%, p < 0.001), with positive postoperative ctDNA independently associated with disease recurrence or death in pure UC (HR = 4.38, 95% CI = 1.66-11.52, p < 0.01) and HS groups (HR = 4.52, 95% CI = 1.86-11.03, p < 0.001). Limitations include the retrospective design and relatively short follow-up.CONCLUSIONS AND CLINICAL IMPLICATIONS: Perioperative ctDNA is a robust biomarker with consistent prognostic value and can refine perioperative risk stratification in patients with BC with pure UC or HS.PMID:42586874 | DOI:10.1016/j.euf.2026.06.026

Prostate. 2026 Jul 23. doi: 10.1002/pros.70220. Online ahead of print.ABSTRACTBACKGROUND: Intraprostatic uptake patterns on 18F-PET/PSMA, such as those defined by the PRIMARY score, have been associated with clinically significant prostate cancer. However, the value of the peripheral focal intense uptake pattern (IFPUP), as a predictor of histologic upgrading after radical prostatectomy remains unclear.OBJECTIVE: To determine whether the IFPUP is associated with histological upgrading in specimens obtained from radical prostatectomy in patients with prostate cancer.METHODS: We performed a retrospective cohort study including patients with localized prostate cancer who underwent PET/PSMA prior to radical prostatectomy between 2022 and 2024. Clinical, imaging, and pathology data were collected. IFPUP was defined as SUVmax ≥ 11.4. Histologic upgrading was defined as an increase in ISUP grade from biopsy to prostatectomy. Associations were evaluated using multivariable logistic regression; diagnostic performance was assessed by AUROC, sensitivity, specificity, and predictive values.RESULTS: Thirty-four patients were included (median age 68 years, median PSA 12 ng/mL). Histologic upgrading occurred in 47.1% (16/34). IFPUP was observed in 33% and was significantly associated with upgrading (56% vs. 12%, p = 0.008). On multivariable analysis, IFPUP remained an independent predictor (OR 16.63, 95% CI 1.42-195.6, p = 0.025). Diagnostic performance of IFPUP included AUROC 0.722 (95% CI 0.574-0.870), sensitivity 56%, specificity 88%, positive predictive value 82%, and negative predictive value 68%.CONCLUSIONS: The presence of IFPUP on PET/PSMA is an independent predictor of histologic upgrading in localized prostate cancer. Its high specificity and positive predictive value suggest clinical utility as a complementary preoperative biomarker for risk stratification, warranting validation in larger cohorts.PMID:42489410 | DOI:10.1002/pros.70220

JCI Insight. 2026 Aug 6:e201872. doi: 10.1172/jci.insight.201872. Online ahead of print.ABSTRACTMetastatic prostate cancer is a clinically and molecularly heterogeneous disease. Under the selective pressure of androgen receptor (AR)-directed therapies, resistant phenotypes frequently emerge, posing significant diagnostic and therapeutic challenges. Neuroendocrine prostate cancer (NEPC) is a clinically important phenotype characterized by lineage plasticity, neuroendocrine features, visceral metastases and poor prognosis. Accurately diagnosing NEPC remains difficult due to its histologic and molecular complexity but has high clinical relevance. In this study, we developed a deep learning model that leverages interpretable cellular features to improve feature extraction from H&E-stained tissue sections (NEURAL-PC). By incorporating a multiple instance learning (MIL) framework, NEURAL-PC enables robust NEPC classification solely from H&E tumor images, achieving an area under the receiver operating characteristic curve (AUROC) of 0.921 in independent external validation. In addition to its diagnostic utility, NEURAL-PC provides prognostic information that enables further subclassification of advanced prostate cancer across diverse datasets supporting its strong prognostic value and generalizability. Broadly, our work highlights a hybrid approach that integrates features across different domains, offering a promising strategy for developing reliable deep learning tools in pathology. Built on this framework, NEURAL-PC represents an extensively validated diagnostic and prognostic model for advanced prostate cancer.PMID:42560769 | DOI:10.1172/jci.insight.201872

Eur Urol Oncol. 2026 Aug 7:S2588-9311(26)00201-4. doi: 10.1016/j.euo.2026.07.011. Online ahead of print.ABSTRACTBACKGROUND AND OBJECTIVE: Detecting localized prostate cancer (PC) with metastatic potential-defined as unfavorable-histology PC (uhPC), comprising Grade Group (GG) ≥3 disease or GG 2 disease with cribriform/intraductal features-is critical for guiding appropriate intervention. We evaluated the utility of the Prostate Imaging Reporting and Data System (PI-RADS) and the automated Restriction Spectrum Imaging restriction score (RSIrs; a biophysics-based quantitative MRI biomarker) for uhPC detection and localization.METHODS: We evaluated patient-level detection of uhPC in a multicenter cohort with biopsy as the reference standard and lesion-level localization in a separate cohort with whole-mount histopathology (WMHP) from radical prostatectomy. The area under the receiver operating characteristic curve (AUC) was calculated to compare patient-level detection of uhPC using PI-RADS and RSIrs. PI-RADS and RSIrs were used to evaluate sensitivity for the most aggressive tumor within the prostate (index tumor) and for all uhPC tumors on WMHP.KEY FINDINGS AND LIMITATIONS: The AUC for patient-level detection of uhPC did not differ significantly between PI-RADS and RSIrs in 1022 patients from five centers (p = 0.13). At the lesion level (n = 103 patients), sensitivity for the index tumor was 87% (95% confidence intervals [CI], 79-94) for PI-RADS, 85% (95% CI, 78-93) for RSIrs, and 93% (95% CI, 86-98) for the two combined. For all uhPC tumors, sensitivity was 81% (95% CI, 73-90) for PI-RADS, 86% (95% CI, 78-93) for RSIrs, and 90% (95% CI, 82-97) for the two combined. A limitation of the lesion-level analyses was that only patients who opted for surgery could be included.CONCLUSIONS AND CLINICAL IMPLICATIONS: MRI showed high sensitivity for detecting uhPC, reinforcing its value for identifying biologically aggressive disease. Both PI-RADS and automated RSIrs may be useful for targeted biopsy and tumor-focused treatment, such as focal radiation dose escalation to aggressive intraprostatic lesions.PMID:42567735 | DOI:10.1016/j.euo.2026.07.011