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Purpose The prostate-specific antigen density (PSAD) helps distinguish between benign prostatic hyperplasia (BPH) and prostate cancer. Accurate prostate volume (PV) assessment is necessary for PSAD calculation and both BPH diagnosis and treatment response monitoring; therefore, accurate PV measurement is increasingly becoming an essential step in the urology. Methods Magnetic resonance imaging was used for PV estimation. A new technique based on single-class support-vector machines (S SVM) for accurate PV estimation was realized. Three estimation methods were compared; method 1: planimetry (reference), method 2: S SVM based, and method 3: prolate ellipsoid. Results Method 1 and method 2 depict a strong correlation (Spearman’s rank correlation coefficient ρ  = 0.965, p  > 0.001). The interrater reliability for method 1 and method 2 readings as expressed by the intraclass correlation coefficient (ICC) was 0.975 ( p  > 0.001). Comparison between method 3 and the two other methods shows ρ  = 0.873 ( p  > 0.001), and ρ  = 0.795 ( p  > 0.001), respectively. ICC was 0.54 and 0.505, respectively. The mean difference between method 1 and method 2 was −0.05 ml. The limits of agreement with the 95 % confidence interval were −3.8 to 3.7 ml. Comparing method 3 and the two other methods shows a worse agreement with mean difference of 8.6 ml (95 % confidence interval of 1.0–16.2 ml) and 8.6 ml (95 % confidence interval of −0.7 to 18.0 ml), respectively. Conclusions The prostate volumes obtained by our technique agreed excellently with the planimetry (reference) method. This new technique would be clinically useful for urologists in prostate volumetric analysis.

The practice of radical prostatectomy for treating prostate cancer has evolved remarkably since its general introduction around 1900. Initially described using a perineal approach, the procedure was later popularized using a retropubic one, after it was first described as such in 1948. The open surgical method has now largely been abandoned in favour of the minimally invasive robot-assisted method, which was first described in 2000. Until 1980, the procedure was hazardous, often accompanied by massive blood loss and poor outcomes. For patients in whom surgery is indicated, prostatectomy is increasingly being used as the first step in a multitherapeutic approach in advanced local, and even early metastatic, disease. However, contemporary molecular insights have enabled many men to safely avoid surgical intervention when the disease is phenotypically indolent and use of active surveillance programmes continues to expand worldwide. In 2020, surgery is not recommended in those men with low-grade, low-volume Gleason 6 prostate cancer; previously these men — a large cohort of ~40% of men with newly diagnosed prostate cancer — were offered surgery in large numbers, with little clinical benefit and considerable adverse effects. Radical prostatectomy is appropriate for men with intermediate-risk and high-risk disease (Gleason score 7–9 or Grade Groups 2–5) in whom radical prostatectomy prevents further metastatic seeding of potentially lethal clones of prostate cancer cells. Small series have suggested that it might be appropriate to offer radical prostatectomy to men presenting with small metastatic burden (nodal and or bone) as part of a multimodal therapeutic approach. Furthermore, surgical treatment of prostate cancer has been reported in cohorts of octogenarian men in good health with minimal comorbidities, when 20 years ago such men were rarely treated surgically even when diagnosed with localized high-risk disease. As medical therapies for prostate cancer continue to increase, the use of surgery might seem to be less relevant; however, the changing demographics of prostate cancer means that radical prostatectomy remains an important and useful option in many men, with a changing indication.In this Perspectives, a pioneer in the field of robotic radical prostatectomy describes the history of the technique and changing indications for its use, from an operation once considered useless, to one offered to almost all patients with low-risk disease, to a procedure that now has a role in advanced disease as part of a multimodal approach.

Objectives Prostate volume (PV) in combination with prostate specific antigen (PSA) yields PSA density which is an increasingly important biomarker. Calculating PV from MRI is a time-consuming, radiologist-dependent task. The aim of this study was to assess whether a deep learning algorithm can replace PI-RADS 2.1 based ellipsoid formula (EF) for calculating PV. Methods Eight different measures of PV were retrospectively collected for each of 124 patients who underwent radical prostatectomy and preoperative MRI of the prostate (multicenter and multi-scanner MRI’s 1.5 and 3 T). Agreement between volumes obtained from the deep learning algorithm (PV DL ) and ellipsoid formula by two radiologists (PV EF1 and PV EF2 ) was evaluated against the reference standard PV obtained by manual planimetry by an expert radiologist (PV MPE ). A sensitivity analysis was performed using a prostatectomy specimen as the reference standard. Inter-reader agreement was evaluated between the radiologists using the ellipsoid formula and between the expert and inexperienced radiologists performing manual planimetry. Results PV DL showed better agreement and precision than PV EF1 and PV EF2 using the reference standard PV MPE (mean difference [95% limits of agreement] PV DL : −0.33 [−10.80; 10.14], PV EF1 : −3.83 [−19.55; 11.89], PV EF2 : −3.05 [−18.55; 12.45]) or the PV determined based on specimen weight (PV DL : −4.22 [−22.52; 14.07], PV EF1 : −7.89 [−30.50; 14.73], PV EF2 : −6.97 [−30.13; 16.18]). Inter-reader agreement was excellent between the two experienced radiologists using the ellipsoid formula and was good between expert and inexperienced radiologists performing manual planimetry. Conclusion Deep learning algorithm performs similarly to radiologists in the assessment of prostate volume on MRI. Key Points • A commercially available deep learning algorithm performs similarly to radiologists in the assessment of prostate volume on MRI. • The deep-learning algorithm was previously untrained on this heterogenous multicenter day-to-day practice MRI data set.

Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms/dysfunction (LUTS/LUTD) in aging men. Over the past 30 years, the prevalence of BPH has increased by 122%, rising from 50.7 million cases in 1990 to 112.5 million in 2021. It is expected that this number will continue to rise over the next 15 years with the global aging population. Although mouse models are invaluable for studying human disease, gross anatomical differences between human and murine prostates complicate their translational relevance for BPH/LUTS research. The purpose of this study was to develop and validate a nanoCT-based imaging approach to enable detailed anatomical analysis of the murine lower urinary tract, with the dual goals of advancing tools for LUTD research and improving the translational relevance of mouse models to human prostate disease. Advancements in nano-computed tomography (nanoCT) have enabled high-resolution characterization of murine organ anatomy, providing new insights into how morphological differences contribute to pathology. To accomplish this, whole lower urogenital tracts from 8-week-old healthy male C57BL/6J mice and microdissected prostatic urethras were imaged on a v|tome|x M or nanotom M nano-CT system, respectively. Images were processed for 2D segmentation and subsequent 3D reconstruction. Our approach enabled high-resolution visualization and characterization of the murine lower urogenital tract, including the urinary bladder, prostate lobes, seminal vesicles, and ductus deferens, as well as the microscopic ductal architecture of the prostatic urethra. The resulting 3D reconstructions preserved native anatomical relationships and allowed for comparisons between murine and human prostate anatomy; however, our findings are limited in that nanoCT is inherently an ex vivo analysis and only healthy, young C57BL/6J mice were used and pathology was not assessed in the current study. Together, these findings establish a method that can be used for assessing anatomical and morphological changes associated with LUTD development, while also highlighting key anatomical similarities that enhance the translational relevance of mouse models for human prostate disease.

Purpose The external urethral sphincter (EUS) is critical for urinary continence, but its complex anatomy is not fully understood, complicating its preservation during prostate surgeries. This study aims to elucidate the anatomy and development of the EUS to enhance surgical techniques for continence preservation. Methods The study consisted of a postmortem examination of three male cadavers, aged 52, 64, and 60, with intact urogenital systems. Specimens including the prostate and EUS were dissected, fixed in formalin, and stained with Hematoxylin-Eosin for microscopic analysis. Histological assessments focused on the muscle composition and structure of the EUS and prostate. Results Macroscopic examination revealed symmetrical prostates without pathologies. Histologically, the anterior prostate lacked tubuloalveolar glands, showing striated muscle fibers from the external urethral sphincter extending into the prostate and prostatic urethra. Reduced glandular structure and prevalent smooth muscle were noted. This intricate integration of striated muscle fibers at the EUS-prostate interface underscores the anatomical complexity vital for surgical preservation of urinary continence. Conclusion Our study reveals a complex EUS-prostate relationship, challenging the view of the EUS as merely a circular muscle. The findings demonstrate the importance of the EUS’s extension into the prostate for urethral stabilization and continence. Recognizing this anatomy is crucial for maintaining urinary continence in prostate surgeries and enhancing postoperative outcomes.

Purpose To describe and categorize the angiographic findings regarding prostatic vascularization, propose an anatomic classification, and discuss its implications for the PAE procedure. Methods Angiographic findings from 143 PAE procedures were reviewed retrospectively, and the origin of the inferior vesical artery (IVA) was classified into five subtypes as follows: type I: IVA originating from the anterior division of the internal iliac artery (IIA), from a common trunk with the superior vesical artery (SVA); type II: IVA originating from the anterior division of the IIA, inferior to the SVA origin; type III: IVA originating from the obturator artery; type IV: IVA originating from the internal pudendal artery; and type V: less common origins of the IVA. Incidences were calculated by percentage. Results Two hundred eighty-six pelvic sides ( n  = 286) were analyzed, and 267 (93.3 %) were classified into I–IV types. Among them, the most common origin was type IV ( n  = 89, 31.1 %), followed by type I ( n  = 82, 28.7 %), type III ( n  = 54, 18.9 %), and type II ( n  = 42, 14.7 %). Type V anatomy was seen in 16 cases (5.6 %). Double vascularization, defined as two independent prostatic branches in one pelvic side, was seen in 23 cases (8.0 %). Conclusions Despite the large number of possible anatomical variations of male pelvis, four main patterns corresponded to almost 95 % of the cases. Evaluation of anatomy in a systematic fashion, following a standard classification, will make PAE a faster, safer, and more effective procedure.

BACKGROUND: The goal of the present meta-analysis was to offer physicians the most evidence-based data concerning the anatomical characteristics of the prostatic artery (PA). MATERIALS AND METHODS: Medical databases including PubMed, Scopus, Embase, Web of Science, Google Scholar and Cochrane Library were searched trough. The overall search process was performed in 3 stages. RESULTS: The results were established based on a total of 7421 arteries. PA was found to originate from an internal pudendal artery with a pooled prevalence of 28.81% (95% CI: 26.23–31.46%). Mean diameter of the PA was found to be 1.52 mm (SE = 0.07). Single PA was found to occur in 76.43% of the patients (95% CI: 60.96–89.12%). CONCLUSIONS: In conclusion, the authors of the present study believe that this is the most accurate and up-to-date analysis regarding the highly variable anatomy of the PA. The PA originates most commonly from the internal pudendal artery (28.81%); however, it may also originate from other pelvic arteries, including the middle anorectal or the superior gluteal arteries. Moreover, accessory PAs may occur, yet, a single main PA supplying the prostate gland is most frequently observed (76.43%). The PA may also form anastomoses with the adjacent arteries (pooled prevalence of 45.20%), which may create a complex vascular network in the pelvis. It is hoped that the current meta-analysis may help to decrease the potential complications that may emerge from diverse endovascular and urological procedures.

Objective To evaluate the impact of the male sexual function following photoselective vaporization of the prostate treatment in different volume of prostates. Methods One hundred and twenty-eight consecutive patients with active sexual ability who underwent prostate vaporization with the green light laser during 2009–2011 were enrolled. We divided all patients into two groups group I (<70 ml, n  = 58) and group II (≥70 ml, n  = 70) according to the volume of prostate. Two group patients were assessed by International Index of Erectile Function (IIEF-5) preoperatively and at 1, 3, 6, 12, and 24 months. We measured the IPSS, QoL, Q max , PRV PSA at the baseline, postoperation and every visit. IIF-5 questionnaires were also collected in every visit. Result One hundred and twenty-eight patients were under successful operations. In the 1, 3, 6, 12 and 24 months, main parameters following operation such as Q max PRV IPSS and QoL scores had significant improved compared to baseline. However, the group II was better than group I in every visits. As the 6, 12 and 24 months of questionnaires, group II had less IIEF scores than group I. To evaluate the adverse sexual outcomes of IIEF-5 lists, the erectile dysfunction and overall unsatisfied scores of group II were much more than group I in 6–24-month visits. Conclusion The larger volume of prostate (≥70 ml) following PVP treatment has negative influence on sexual function in the long term (more than 6 months). The adverse sexual outcomes were significant increased after PVP in the prostate with more than 70-ml volume.

Cancer is a global issue, and it is expected to have a major impact on our continuing global health crisis. As populations age, we see an increased incidence in cancer rates, but considerable variation is observed in survival rates across different geographical regions and cancer types. Both breast and prostate cancer are leading causes of morbidity and mortality worldwide. Although cancer statistics indicate improvements in some areas of breast and prostate cancer prevention, diagnosis, and treatment, such statistics clearly convey the need for improvements in our understanding of the disease, risk factors, and interventions to improve life span and quality of life for all patients, and hopefully to effect a cure for people living in developed and developing countries. This concise review compiles the current information on statistics, pathophysiology, risk factors, and treatments associated with breast and prostate cancer.

ABSTRACT Purpose: The aim of this study was to quantitatively analyze the stromal components of the prostate (collagen, muscle fibers and elastic system fibers) during prostate development in normal human fetuses, in order to establish normal growth patterns. Materials and Methods: Twenty-one normal human fetuses, aged between 12- and 22-weeks post-conception (WPC), were studied. The fetuses were divided into three groups: G1, n = 7, 12 to 16 WPC; G2, n = 6, 17 to 19 WPC, and G3, n = 8, 20 to 22 WPC. The samples were fixed in 4% buffered formalin and processed for paraffin embedding for histochemical analysis. Five 5-micrometer-thick sections were taken from each sample and stained using histochemical techniques to identify the prostate stromal components. Histomorphometric analyses were carried out by evaluating the area density of the parameters analyzed, in percentage, using ImageJ software. Results: The quantitative analysis of collagen fibers (p = 0.0616) and elastic system fibers (p = 0.6049) showed no significant difference between groups. Smooth muscle fibers were higher in G2 (+82.38%) and G3 (+108.81%) when compared to G1, p = 0.0020. Linear regression of the entire fetal period studied (12 to 22 WPC) showed a proportional increase in muscle fibers in relation to gestational age (r2 = 0.3398; p = 0.0056). Linear regression revealed a strong negative correlation between collagen fibers and smooth muscle fibers in G3 (20 to 22 WPC) (r2 = 0.8209; p = 0.0019). Conclusions: Changes in the stromal components of the prostate are more significant from the end of the second trimester of pregnancy. Collagen fibers and elastic system fibers showed stable growth throughout the fetal period studied. The density of smooth muscle fibers increased about twofold with increasing fetal age.