Jievaltas, Mindaugas

Introduction & Objectives: Background: Artificial urinary sphincter (AUS) is widely used to treat male stress urinary incontinence, most often after prostate surgery. In emergency settings, AUS may be overlooked, especially when the patient is unable to provide medical history due to delirium or altered mental status. This may result in severe iatrogenic complications. Materials & Methods: Case presentation: We report a case of a male patient with an implanted AUS who presented with acute urinary retention and delirium. As the medical history was unavailable, transurethral catheterization was performed without prior deactivation of the sphincter cuff. Prolonged urethral compression led to ischemia and subsequent urethral necrosis at the cuff level. Results: Discussion: This case highlights the importance of careful physical examination. Palpation of the scrotum may reveal an AUS pump and prevent inappropriate catheterization. In non-specialized centers, urinary drainage in patients with AUS should preferably be achieved by percutaneous cystostomy rather than transurethral catheterization. Conclusions: When patient history is unavailable, examination and correct choice of urinary drainage are crucial Awareness of AUS can prevent severe and avoidable complications.

Introduction & Objectives: Multiparametric magnetic resonance imaging (MRI), with or without MRI-targeted biopsy, is getting the important role as an alternative test to systematic transrectal ultrasonography-guided biopsy in men suspected of prostate cancer. Cognitive fusion biopsy method is underrated and we need more detailed evidence-based decision-making on which investigation to use for diagnosing prostate cancer. Objectives: This study aims to evaluate the improvement in concordance of prostatectomy specimens with prostate biopsy (PB) histopathology obtained using the cognitive MRI-fusion approach compared with the 10-core transrectal systemic biopsy and determining the influencing factors. Materials & Methods: A single-centre prospective study included 351 men scheduled for initial prostate biopsy between January 2021 and July 2025 due to elevated total PSA levels or abnormal digital rectal examination (DRE). Biopsies were performed based on multiparametric magnetic resonance imaging (mpMRI) findings. 76 patients underwent radical prostatectomy. The patients were divided into groups based on the biopsy method: 69 patients underwent only systemic transrectal biopsy and 282 patients underwent transrectal systemic and targeted biopsy. The histopathological grading of these biopsy specimens was compared with that of radical prostatectomy specimens. Multivariate logistic regression analyses were conducted to evaluate the impact of various criteria on histopathological concordance. Results: Cognitive MRI-fusion PB had a significantly higher upgrading of prostatectomy histopathology than systemic PB in all Gleason grade categories. Systemic PB showed significantly better concordance with prostatectomy histopathology than MRI-fusion PB (100 % vs. 64,79 %, p < 0.01), but the sample of patients with systemic PB was too small. PI-RADS score is an independent predictor for concordance (OR = 1,72, 95%CI = 1,27 – 2,32, p = 0.01) and downgrading (OR = 0.18, 95%CI = 0.05-0.61, p = 0.01). In biopsy specimens detected clinically significant prostate cancer showed ability to predict concordance (OR = 4.74, 95%CI = 1.27 – 17.64, p = 0.02) and upgrading (OR = 0.1, 95%CI = 0.02 – 0.49, p = 0.01) with the prostatectomy histopathological results. Conclusions: Performed MRI and PI-RADS score are independent predictors of the concordance between biopsy and final histopathology after prostatectomy and post-prostatectomy histopathology downgrading. Detected clinically significant prostate cancer leads to the expectation of better histological concordance and lower upgrading. Despite limitations, these findings underscore the potential of systemic and cognitive targeted PB for detecting prostate cancer more accurately in clinical practice, advocating for larger cohorts to validate these results.

Introduction & Objectives: The aim of this study was to evaluate whether MSKCC pre-radical prostatectomy prostate cancer nomograms are a reliable method for predicting prostate cancer (PCa) recurrence-free survival (RFS) after I-125 seeds brachytherapy. Objectives: a) To calculate 5- and 10-year biochemical recurrence-free survival (RFS) probabilities using MSKCC nomograms in patients treated with I-125 brachytherapy. b) To compare nomogram-predicted and actual recurrence free PCa outcomes. c) To evaluate the impact of tumor extension parameters (extracapsular extension (ECE) seminal vesicle invasion (SVI), lymph node invasion (LNI)) on PCa recurrence risk. Materials & Methods: Patients diagnosed with PCa and treated with LDR brachytherapy between the years 2007 and 2024 in the Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, were included into this retrospective study. Medical records of 645 patients were analyzed, collecting demographic and clinical data including age, prostate-specific antigen (PSA) levels, biopsy results, Gleason score, and biochemical recurrence. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 30.0. Results: The mean patient age was 63±7 years (range 39–88). During a mean follow-up of 10±5.4 years, 34 patients developed recurrence and 19 died from PCa. In our study PCa recurrence-free survival was 96% at 5 years and 94% at 10 years. MSKCC nomogram calculated predictions were 86±11% for 5 years and 77±14% for 10-years PCa recurrence-free survival; predicted probabilities were related to actual outcomes (p<0.001) but underestimated real results of our study. Calculated ECE probability was higher in patients with PCa recurrence group compared to PCa recurrence-free patients (49±20% vs 33±16%, p<0.001). In univariate analysis, ECE, SVI, and LNI were significant predictors of PCa recurrence (p<0.001), but in multivariate analysis only ECE remained significant: each 1% increase was associated with a 5% higher recurrence risk (HR 1.05, p<0.001). Patient age was not a significant predictor. Conclusions: Observed 5- and 10-year PCa recurrence-free survival rates after LDR brachytherapy were 96% and 94%, respectively. MSKCC nomogram predicted the probability of PCa progression-free survival after I-125 seeds brachytherapy but their prognosis was worse than our study data. Among tumor extension parameters, ECE probability was an independent predictor of PCa recurrence, whereas seminal vesicle invasion and lymph node invasion were not significant in multivariate analysis. These findings suggest that more precise prediction models are needed for patients treated with LDR brachytherapy.

Purpose Prostate cancer associated 3 (PCA3) and TMPRSS2:ERG fusion (T:E) are established urinary RNA biomarkers for detecting clinically significant prostate cancer (csPCa, Grade Group ≥ 2). Large within-subject paired studies directly comparing post-DRE and non-DRE urine collection are lacking. Using a multicenter cohort with samples collected from the same patients, we evaluated the effect of urine collection method on PCA3 and T: E diagnostic performance.

Methods In a multicenter prospective study paired post-DRE and non-DRE whole-urine samples were collected before systematic biopsy. PCA3, T:E, and reference PSA RNAs were quantified in 373 post-DRE and 355 non-DRE eligible specimens. Logistic regression models combining PCA3, T:E, PSA density, and age were developed for post-DRE (PD2) and non-DRE (ND2) cohorts and evaluated by cross-validated receiver operating characteristic (ROC) analysis and decision curve analysis.

Results PD2 outperformed ND2 in discrimination (AUC 0.78 versus 0.73) and net benefit. At ~ 95% sensitivity, PD2 specificity was 32% versus 23% for ND2. In the paired-sample analysis (n = 333), adding PCA3 and T:E to clinical variables improved AUC from 0.70 to 0.80 for post-DRE urine (p = 0.003), while gains were non-significant for non-DRE urine. Post-DRE specimens showed markedly higher RNA yields (median ~ 20-fold higher PCA3 and T:E copy numbers).

Conclusions Post-DRE whole urine collection increased biomarker RNA yield and significantly improved csPCa diagnostic accuracy versus non-DRE whole urine. PCA3 and T:E provided meaningful additive value only in post-DRE specimens, supporting its preferred use. As biopsies were performed without MRI guidance, future studies in MRI-integrated pathways would further characterize clinical utility.

Background. In patients with metastatic hormone-sensitive prostate cancer (mHSPC), darolutamide significantly improved radiological progression-free survival versus placebo (hazard ratio [HR] 0·54, 95% CI 0·41-0·71) in the phase 3 ARANOTE study. In addition to survival, symptom control and health-related quality of life (HRQoL) are important factors in treatment decision making; we therefore report pain, HRQoL, and safety outcomes from the ARANOTE trial.

Background: An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor, sometimes with urinary bladder involvement (though this is extremely uncommon). Due to its rarity, the exact etiology and optimal treatment strategy remain unclear. Methods: A review of the existing literature on IMT of the urinary bladder was performed. Results: We report a case of a 32-year-old female presenting with frequent urination, hematuria with clots, and lower abdominal pain for one month. Initially misdiagnosed as acute cystitis, the symptoms persisted despite antibiotic therapy. Laboratory findings revealed severe anemia, and imaging studies identified a large bladder mass. Transurethral resection of the bladder tumor (TURB) was performed, and a 96 g mass was removed. Histopathological examination confirmed IMT of the urinary bladder (IMTUB) with positive immunohistochemical staining for ALK, vimentin, and actin. Follow-up at 30 months showed no recurrence, with annual cystoscopy and CT scans confirming remission. Conclusions: IMTUB should be considered in young patients presenting with hematuria and lower urinary tract symptoms. Early diagnosis through cystoscopy, imaging, and histopathological confirmation is essential for appropriate management. TURB remains the gold standard for treatment, with ALK inhibitors providing additional therapeutic options in select cases. Long-term follow-up is necessary due to the unknown malignant potential of IMTUB.

Background/Objectives: The role of extended pelvic lymph node dissection (ePLND) in prostate cancer remains uncertain. Sentinel lymph node (sLN) mapping improves diagnostic precision, yet some patients have no detectable sentinel nodes (“untraceable” sLNs). This study evaluates whether untraceable sLNs predict the absence of lymph node invasion (LNI) and can guide surgical decision-making during radical prostatectomy (RP) with ePLND. Methods: Patients with intermediate- or high-risk prostate cancer and with no radiologically evident LNI were included in the study. A 99mTc-nanocolloid was used as an sLN tracer. RP with sLN dissection and ePLND was performed <20 h after injection. Patients were categorized into two groups: Group 1, traceable sLNs and Group 2, untraceable sLNs (no radiological or intraoperative signal). Results: A total of 53 patients were included. LNI was present in 10 patients (18.9%). Group 1 had 41 patients (77.4%), and Group 2 had 12 patients (22.6%). None of the patients in Group 2 had LNI following ePLND, whereas 10 of 41 patients (24.4%) in Group 1 were node-positive (p = 0.016). Baseline clinical and pathological characteristics were comparable between groups. A total of 17/53 of men (32.1%) experienced biochemical recurrence, overall, with higher observed events in Group 1 (15/41, 36.6%) vs. Group 2 (2/12, 16.7%). However, this difference did not reach statistical significance (p = 0.2). Conclusions: A proportion of PCa patients have no radiologically or intraoperatively detectable sLNs, and none of the patients with untraceable sLNs exhibited LNI following ePLND. These findings suggest that untraceable sLNs may correlate with an extremely low probability of nodal invasion and could serve as a criterion for safely omitting ePLND in selected patients.

Background: Bladder leiomyosarcoma is an extremely rare non-urothelial malignancy, accounting for less than 0.1% of all bladder tumors. It presents significant diagnostic and therapeutic challenges due to its aggressive nature and the absence of standardized treatment protocols. Case presentation: We report the case of a 61-year-old woman who presented with hematuria, dysuria, and suprapubic pain. Imaging revealed a large, locally invasive bladder mass, and histopathological examination following transurethral resection confirmed leiomyosarcoma. The patient underwent radical cystectomy with resection of adjacent bowel segments and urinary diversion. Histology showed a high-grade leiomyosarcoma (pT3N0) with extensive necrosis and a high mitotic index. Two months postoperatively, peritoneal dissemination was detected. Systemic chemotherapy with dacarbazine and doxorubicin initially led to the regression of metastases, but disease progression occurred within months, including lung, liver, and bone metastases. Palliative radiotherapy and second-line chemotherapy were initiated. As of now, 16 months have elapsed since surgery. Conclusions: This case underscores the aggressive clinical course of bladder leiomyosarcoma despite multimodal therapy and the urgent need for individualized management strategies. Given its rarity, this case contributes to the limited literature and highlights the importance of vigilant follow-ups and further studies to establish evidence-based treatment protocols.

Despite advances in diagnostic tools, a reliable and standardized algorithm for accurately identifying clinically significant prostate cancer in patients prior to their first prostate biopsy has yet to be established. Traditional methods such as prostate-specific antigen testing, digital rectal examination, and systematic biopsy often suffer from limited sensitivity and specificity, leading to an increased risk of both unnecessary biopsies and missed significant cases. The aim of this study was to evaluate and compare the diagnostic value of multiparametric magnetic resonance imaging (mpMRI), urinary genetic biomarkers (PCA3 and T:E), and the PCPTRC2 risk calculator in detecting clinically significant prostate cancer. The study included men who underwent all of the mentioned diagnostic tests followed by a prostate biopsy. Findings revealed that mpMRI demonstrated high sensitivity, but low specificity. Combining all three methods yielded the highest sensitivity but significantly reduced specificity, making this combination suitable only for high-risk patients. The most effective early diagnostic approach was the combination of mpMRI and urinary biomarkers, which reduced unnecessary biopsies while maintaining detection of clinically significant cases. The study highlights the importance of a personalized and combined diagnostic strategy for the detection of clinically significant prostate cancer.

Introduction & Objectives: Chronic inflammation has been increasingly recognized as a contributing factor in prostate cancer (PCa) development and progression. Pro-inflammatory cytokines and immune mediators are known to influence tumor initiation, immune evasion, and disease progression. However, their specific diagnostic potential in distinguishing PCa from benign conditions remains unclear. This study aims to investigate the association between inflammatory markers in serum and prostate biopsy tissue with PCa presence. Specifically, we seek to (1) identify inflammatory cytokines that differ significantly between PCa patients and cancer-free controls, (2) assess their potential as diagnostic biomarkers, and (3) determine whether inverse associations between inflammatory markers in prostate tissue suggest a protective role in PCa development. Materials & Methods: This prospective study included 60 PCa patients and 22 cancer-free controls enrolled in Lithuania's PSA-based early detection program. Ethical approval was obtained from the Regional Bioethics Committee (Permission No. BE-2-10). To minimize confounding effects, patients with underlying inflammatory conditions were excluded. Serum and prostate biopsy samples were analyzed for IL-2, IL-4, IL10, IL-13, IL-33, Oncostatin M, TNF-alpha, PDGF-BB, and TREM-1 using Luminex technology. Statistical analyses included the MannWhitney U test, logistic regression, and ROC curve analysis to assess marker distribution and diagnostic performance. Results: PCa patients exhibited significantly higher serum levels of IL-2 (p = 0.001), IL-10 (p < 0.001), IL-33 (p < 0.001), Oncostatin M (p = 0.018), and TNF-alpha (p = 0.017) compared to controls. In contrast, biopsy tissue levels of IL-4 (p < 0.001), IL-10 (p < 0.001), IL-13 (p = 0.004), Oncostatin M (p = 0.012), PDGF-BB (p = 0.039), and TREM-1 (p = 0.013) were significantly lower in PCa patients, suggesting a potential protective role. Logistic regression revealed that higher IL-2 and IL-33 in serum increased PCa risk (OR = 3.38, p = 0.010; OR = 1.77, p = 0.021, respectively), while IL-4 and IL-13 in biopsy tissue were inversely associated with PCa (OR = 0.313, p < 0.001; OR = 0.159, p = 0.008, respectively). ROC analysis demonstrated that IL-10 in serum (AUC = 0.788, sensitivity = 69.2%, specificity = 81.0%) and IL-4 (inverted) in biopsy samples (AUC = 0.804, sensitivity = 72.7%, specificity = 81.7%) had the strongest discriminative ability for PCa detection. Conclusions: This study highlights IL-4, IL-10, and IL-13 in biopsy tissue as potential protective biomarkers, whereas elevated IL-2 and IL-33 in serum are associated with increased PCa risk. The exclusion of patients with inflammatory conditions strengthens the validity of these findings. These results support the potential role of inflammatory markers in PCa diagnosis and risk stratification, warranting further validation in larger cohorts.