Bellouti Ayoub, Sirtaine Nicolas, Roumeguere Thierry, Peltier Alexandre, Diamand Romain
Department of Urology, Jules Bordet Institute-Erasme Hospital, Brussels University Hospital, Brussels, Belgium.
Department of Pathology, Jules Bordet Institute, Brussels University Hospital, Brussels, Belgium.
World J Urol. 2025 Aug 25;43(1):509. doi: 10.1007/s00345-025-05853-5.
Current risk stratification systems for prostate cancer (PCa) lack precision, particularly for intermediate-risk patients. PTEN loss has emerged as a promising biomarker for predicting aggressive disease. This study aims to evaluate the prognostic value of PTEN status in patients diagnosed via magnetic resonance imaging (MRI)-targeted biopsy and treated with radical prostatectomy (RP).
A retrospective analysis was conducted on a cohort of 213 patients diagnosed via MRI-targeted biopsy with available PTEN testing between 2020 and 2023 at a referral center. Patients who underwent RP with undetectable postoperative PSA levels and a minimum follow-up of three months were included. The primary outcome was the prognostic value of PTEN status. Biochemical recurrence (BCR) after RP was analyzed using Kaplan-Meier analysis and the log-rank test, while Cox regression models identified predictors of BCR.
Overall, 36/213 (17%) patients exhibited PTEN loss. These patients had more aggressive disease, characterized by higher clinical stage and ISUP grade group (p ≤ 0.01). Among the 56 patients treated with RP and followed for a median of 25 months, BCR-free survival was significantly lower in those with PTEN loss, especially in the intermediate-risk subgroup (log-rank test, p = 0.03). PTEN loss was identified as an independent predictor of BCR (Hazard Ratio: 8.5, p = 0.03).
PTEN loss in patients diagnosed via MRI-targeted biopsy and treated with RP is associated with worse prognosis. PTEN testing shows promise as a biomarker to improve patient counseling and guide PCa treatment decisions. Prospective studies with longer follow-up periods are needed to validate these findings fully.
目前前列腺癌（PCa）的风险分层系统缺乏精准性，尤其是对于中危患者。PTEN缺失已成为预测侵袭性疾病的一个有前景的生物标志物。本研究旨在评估PTEN状态在经磁共振成像（MRI）靶向活检诊断并接受根治性前列腺切除术（RP）治疗的患者中的预后价值。
对2020年至2023年在一家转诊中心通过MRI靶向活检诊断且有可用PTEN检测结果的213例患者进行回顾性分析。纳入术后PSA水平不可测且至少随访3个月的接受RP的患者。主要结局是PTEN状态的预后价值。使用Kaplan-Meier分析和对数秩检验分析RP后的生化复发（BCR），同时Cox回归模型确定BCR的预测因素。
总体而言，36/213（17%）例患者存在PTEN缺失。这些患者的疾病侵袭性更强，表现为临床分期和国际泌尿病理学会（ISUP）分级组更高（p≤0.01）。在56例接受RP并中位随访25个月的患者中，PTEN缺失患者的无BCR生存期显著更低，尤其是在中危亚组中（对数秩检验，p=0.03）。PTEN缺失被确定为BCR的独立预测因素（风险比：8.5，p=0.03）。
经MRI靶向活检诊断并接受RP治疗的患者中，PTEN缺失与预后较差相关。PTEN检测有望作为一种生物标志物，以改善患者咨询并指导PCa治疗决策。需要进行更长随访期的前瞻性研究来充分验证这些发现。
