The impact of intravesical prostatic protrusion on the diagnosis and treatment of prostate cancer

doi:10.3877/cma.j.issn.1674-3253.2026.04.015

Abstract

Abstract:

As a morphological alteration of the prostate, intravesical prostatic protrusion (IPP) is conventionally utilized to assess lower urinary tract symptoms, particularly in benign prostatic hyperplasia (BPH). However, a growing body of recent evidence indicates that IPP exerts a significant influence on the diagnosis and treatment of prostate cancer (PCa). Diagnostically, IPP may serve as an auxiliary indicator for PCa detection. Therapeutically, IPP can impact the efficacy of radical prostatectomy, modulate postoperative complication rates, and consequently affect long-term prognosis. Therefore, it is imperative for surgeons to conduct precise preoperative assessments of IPP and formulate individualized surgical strategies to mitigate adverse outcomes and harness the clinical utility of IPP in the management of PCa.

Key words: Prostate cancer, Intravesical prostatic protrusion

Shusheng Yuan, Weimin Chen, Hanzhen Huang. The impact of intravesical prostatic protrusion on the diagnosis and treatment of prostate cancer[J]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(04): 468-473.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2026.04.015

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2026/V20/I04/468

References 50

[1]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660.
[2]	He S, Xia C, Li H, et al. Cancer profiles in China and comparisons with the USA: a comprehensive analysis in the incidence, mortality, survival, staging, and attribution to risk factors[J]. Sci China Life Sci, 2024, 67(1): 122-131. DOI: 10.1007/s11427-023-2423-1.
[3]	Martinez O, Murphy C, Bsatee A, et al. Impact of Median lobe on urinary function after robotic prostatectomy[J]. Prostate, 2021, 81(12): 832-837. DOI: 10.1002/pros.24179.
[4]	Ohnishi K, Watanabe H, Ohe H, et al. Development and clinical significance of protrusion of hypertrophic prostate into the bladder observed by transrectal ultrasonotomography[J]. Jpn J Urol, 1985, 76(8): 1194-1200. DOI: 10.5980/jpnjurol1928.76.8_1194.
[5]	Moussaoui G, Zakaria AS, Negrean C, et al. Accuracy of clarius, handheld wireless point-of-care ultrasound, in evaluating prostate morphology and volume compared to radical prostatectomy specimen weight: is there a difference between transabdominal vs transrectal approach?[J]. J Endourol, 2021, 35(9): 1300-1306. DOI: 10.1089/end.2020.0874.
[6]	Kaplan SA. Re: intravesical prostatic protrusion as a predictor of early urinary continence recovery after laparoscopic radical prostatectomy[J]. J Urol, 2016, 195(1): 137-138. DOI: 10.1016/j.juro.2015.10.048.
[7]	Chia SJ, Heng CT, Chan SP, et al. Correlation of intravesical prostatic protrusion with bladder outlet obstruction[J]. BJU Int, 2003, 91(4): 371-374. DOI: 10.1046/j.1464-410x.2003.04088.x.
[8]	王亚申, 罗飞, 李健. 基于临床因素的tPSA 4~10 ng/ml前列腺癌风险分析[J]. 现代泌尿生殖肿瘤杂志, 2025, 17(1): 14-18. DOI: 10.3870/j.issn.1674-4624.2025.01.004.
[9]	余丽娜, 罗翠, 刘双苔, 等. 前列腺癌筛查健康信念量表的编制与信效度检验[J]. 医学新知, 2025, 35(1): 65-72. DOI: 10.12173/j.issn.1004-5511.202406044.
[10]	Kachuri L, Hoffmann TJ, Jiang Y, et al. Genetically adjusted PSA levels for prostate cancer screening[J]. Nat Med, 2023, 29(6): 1412-1423. DOI: 10.1038/s41591-023-02277-9.
[11]	陈原杰, 余天一, 李望. 前列腺健康指数联合PI-RADS评分在血清前列腺特异性抗原4~10 μg/L前列腺癌患者中的诊断价值[J]. 徐州医科大学学报, 2025, 45(2): 146-150. DOI: 10.12467/j.issn.2096-3882.20240343.
[12]	Xu D, Yu Y, Zhu Y, et al. A new model consists of intravesical prostatic protrusion, prostate volume and serum prostatic-specific antigen in the evaluation of prostate cancer[J]. Pathol Oncol Res, 2014, 20(2): 439-443. DOI: 10.1007/s12253-013-9714-1.
[13]	Simmons LAM, Kanthabalan A, Arya M, et al. Accuracy of transperineal targeted prostate biopsies, visual estimation and image fusion in men needing repeat biopsy in the PICTURE trial[J]. J Urol, 2018, 200(6): 1227-1234. DOI: 10.1016/j.juro.2018.07.001.
[14]	Rosenberg JE, Jarosek S, Spilseth B, et al. Diagnosing prostate cancer: the role of intravesical prostatic gland protrusion on accuracy of prostate biopsies[J]. J Urol, 2022, 207(6): 1207-1213. DOI: 10.1097/ju.0000000000002448.
[15]	Spohn S, Jaegle C, Fassbender TF, et al. Intraindividual comparison between 68Ga-PSMA-PET/CT and mpMRI for intraprostatic tumor delineation in patients with primary prostate cancer: a retrospective analysis in 101 patients[J]. Eur J Nucl Med Mol Imaging, 2020, 47(12): 2796-2803. DOI: 10.1007/s00259-020-04827-6.
[16]	Li M, Guo J, Hu P, et al. Tomoelastography based on multifrequency MR elastography for prostate cancer detection: comparison with multiparametric MRI[J]. Radiology, 2021, 299(2): 362-370. DOI: 10.1148/radiol.2021201852.
[17]	Guo Z, Qin X, Mu R, et al. Amide proton transfer could provide more accurate lesion characterization in the transition zone of the prostate[J]. J Magn Reson Imaging, 2022, 56(5): 1311-1319. DOI: 10.1002/jmri.28204.
[18]	Fletcher P, de Santis M, Ippoliti S, et al. Vector prostate biopsy: a novel magnetic resonance imaging/ultrasound image fusion transperineal biopsy technique using electromagnetic needle tracking under local anaesthesia[J]. Eur Urol, 2023, 83(3): 249-256. DOI: 10.1016/j.eururo.2022.12.007.
[19]	Kawada T, Yanagisawa T, Rajwa P, et al. Diagnostic performance of prostate-specific membrane antigen positron emission tomography-targeted biopsy for detection of clinically significant prostate cancer: a systematic review and meta-analysis[J]. Eur Urol Oncol, 2022, 5(4): 390-400. DOI: 10.1016/j.euo.2022.04.006.
[20]	Qiu DX, Li J, Zhang JW, et al. Dual-tracer PET/CT-targeted, mpMRI-targeted, systematic biopsy, and combined biopsy for the diagnosis of prostate cancer: a pilot study[J]. Eur J Nucl Med Mol Imaging, 2022, 49(8): 2821-2832. DOI: 10.1007/s00259-021-05636-1.
[21]	Meeks JJ, Zhao L, Greco KA, et al. Impact of prostate Median lobe anatomy on robotic-assisted laparoscopic prostatectomy[J]. Urology, 2009, 73(2): 323-327. DOI: 10.1016/j.urology.2008.08.484.
[22]	Tang J, Xi W, Zhu Y, et al. Clinical significance of preoperative assessment of intravesical prostatic protrusion in radical prostatectomy[J]. J Cancer, 2023, 14(15): 2889-2894. DOI: 10.7150/jca.86582.
[23]	Peyrottes A, Dariane C, Baboudjian M, et al. Anatomic factors associated with complications after radical prostatectomy: a systematic review and meta-analysis[J]. Eur Urol Oncol, 2025, 8(2): 554-570. DOI: 10.1016/j.euo.2024.10.018.
[24]	张长升, 徐涛, 张劲松, 等. PI-RADS 3分前列腺增生与前列腺癌穿刺患者的临床特征分析[J]. 现代泌尿生殖肿瘤杂志, 2025, 17(3): 167-171, 190. DOI: 10.3870/j.issn.1674-4624.2025.03.005.
[25]	Jeong CW, Lee S, Oh JJ, et al. Quantification of Median lobe protrusion and its impact on the base surgical margin status during robot-assisted laparoscopic prostatectomy[J]. World J Urol, 2014, 32(2): 419-423. DOI: 10.1007/s00345-013-1118-z.
[26]	张帆, 郝一昌, 杨斌, 等. 前列腺突入膀胱与腹腔镜根治性前列腺切除术后切缘阳性的相关性研究[J]. 中华泌尿外科杂志, 2020, 41(9): 656-660. DOI: 10.3760/cma.j.cn112330-20200409-00279.
[27]	Huang AC, Kowalczyk KJ, Hevelone ND, et al. The impact of prostate size, Median lobe, and prior benign prostatic hyperplasia intervention on robot-assisted laparoscopic prostatectomy: technique and outcomes[J]. Eur Urol, 2011, 59(4): 595-603. DOI: 10.1016/j.eururo.2011.01.033.
[28]	Srougi M, Nesrallah LJ, Kauffmann JR, et al. Urinary continence and pathological outcome after bladder neck preservation during radical retropubic prostatectomy: a randomized prospective trial[J]. J Urol, 2001, 165(3): 815-818. DOI: 10.1016/S0022-5347(05)66534-2.
[29]	Yossepowitch O, Briganti A, Eastham JA, et al. Positive surgical margins after radical prostatectomy: a systematic review and contemporary update[J]. Eur Urol, 2014, 65(2): 303-313. DOI: 10.1016/j.eururo.2013.07.039.
[30]	Hamidi N, Atmaca AF, Canda AE, et al. Does presence of a Median lobe affect perioperative complications, oncological outcomes and urinary continence following robotic-assisted radical prostatectomy?[J]. Urol J, 2018, 15(5): 248-255. DOI: 10.22037/uj.v0i0.4276.
[31]	Coelho RF, Chauhan S, Guglielmetti GB, et al. Does the presence of Median lobe affect outcomes of robot-assisted laparoscopic radical prostatectomy?[J]. J Endourol, 2012, 26(3): 264-270. DOI: 10.1089/end.2011.0132.
[32]	Jenkins LC, Nogueira M, Wilding GE, et al. Median lobe in robot-assisted radical prostatectomy: evaluation and management[J]. Urology, 2008, 71(5): 810-813. DOI: 10.1016/j.urology.2007.12.054.
[33]	Wagaskar VG, Zaytoun O, Kale P, et al. Technical tips in managing large Median lobes during robot-assisted radical prostatectomy[J]. Eur Urol Open Sci, 2022, 45: 32-37. DOI: 10.1016/j.euros.2022.08.017.
[34]	Molinari A, Simonelli G, De Concilio B, et al. Is ureteral stent placement by the transurethral approach during robot-assisted radical prostatectomy an effective option to preoperative technique?[J]. J Endourol, 2014, 28(8): 896-898. DOI: 10.1089/end.2014.0061.
[35]	Patel SR, Kaplon DM, Jarrard D. A technique for the management of a large Median lobe in robot-assisted laparoscopic radical prostatectomy[J]. J Endourol, 2010, 24(12): 1899-1901. DOI: 10.1089/end.2010.0074.
[36]	Vickers AJ, Bianco FJ, Serio AM, et al. The surgical learning curve for prostate cancer control after radical prostatectomy[J]. J Natl Cancer Inst, 2007, 99(15): 1171-1177. DOI: 10.1093/jnci/djm060.
[37]	Ma BL, Yao L, Yu W, et al. The Institute of Urology, Peking University prostatectomy score: a simple preoperative classification of prostate cancer for predicting surgical difficulty and risk[J]. Asian J Androl, 2018, 20(6): 581-586. DOI: 10.4103/aja.aja_39_18.
[38]	Chen SH, Ke ZB, Wu YP, et al. Predictors of prolonged laparoscopic radical prostatectomy and the creation of a scoring system for the duration[J]. Cancer Manag Res, 2020, 12: 8005-8014. DOI: 10.2147/CMAR.S265480.
[39]	Barakat B, Othman H, Gauger U, et al. Retzius sparing radical prostatectomy versus robot-assisted radical prostatectomy: which technique is more beneficial for prostate cancer patients (MASTER study)? a systematic review and meta-analysis[J]. Eur Urol Focus, 2022, 8(4): 1060-1071. DOI: 10.1016/j.euf.2021.08.003.
[40]	Tappero S, Dell’Oglio P, Longoni M, et al. Challenging cases in high-risk prostate cancer patients treated with Retzius-sparing robot-assisted radical prostatectomy[J]. World J Urol, 2022, 40(8): 1993-1999. DOI: 10.1007/s00345-022-04073-5.
[41]	钱佳俊, 张梦洁, 邱雪峰, 等. 保留Retzius间隙的机器人辅助根治性前列腺切除术在中叶突出患者中的优势[J]. 中国肿瘤外科杂志, 2021, 13(4): 335-339. DOI: 10.3969/j.issn.1674-4136.2021.04.005.
[42]	向豫, 李文成. 前列腺癌根治性切除术后尿失禁的新型微创治疗研究进展[J]. 现代泌尿生殖肿瘤杂志, 2025, 17(3): 212-216. DOI: 10.3870/j.issn.1674-4624.2025.03.017.
[43]	Gu Z, Zheng Z, Zhang W, et al. The development and assessment of a predicting nomogram for the recovery of immediate urinary continence following laparoscopic radical prostatectomy[J]. Front Surg, 2022, 9: 1071093. DOI: 10.3389/fsurg.2022.1071093.
[44]	Zhang F, Chu H, Hao Y, et al. Preoperative predictive model of early urinary continence recovery after laparoscopic radical prostatectomy[J]. World J Urol, 2023, 41(1): 59-65. DOI: 10.1007/s00345-022-04198-7.
[45]	van Dijk-de Haan MC, Boellaard TN, Tissier R, et al. Value of different magnetic resonance imaging-based measurements of anatomical structures on preoperative prostate imaging in predicting urinary continence after radical prostatectomy in men with prostate cancer: a systematic review and meta-analysis[J]. Eur Urol Focus, 2022, 8(5): 1211-1225. DOI: 10.1016/j.euf.2022.01.015.
[46]	Yang B, Zhang F, Xiao C, et al. Impact of preoperative magnetic resonance imaging anatomic features on urinary continence recovery after laparoscopic radical prostatectomy[J]. Urol Int, 2020, 104(3-4): 239-246. DOI: 10.1159/000506021.
[47]	Rajih E, Meskawi M, Alenizi AM, et al. Perioperative predictors for post-prostatectomy urinary incontinence in prostate cancer patients following robotic-assisted radical prostatectomy: Long-term results of a Canadian prospective cohort[J]. J De L’association Des Urol Du Can, 2019, 13(5): E125-E131. DOI: 10.5489/cuaj.5356.
[48]	Peigne C, Fournier G, Dissaux G, et al. Minimal channel GreenLight photovaporization before permanent implant prostate brachytherapy for patients with obstructive symptoms: Technically feasible and safe[J]. Brachytherapy, 2021, 20(1): 50-57. DOI: 10.1016/j.brachy.2020.08.003.
[49]	Muraki K, Hattori C, Ogo E, et al. Analysis of radioactive implant migration in patients treated with iodine-125 seeds for permanent prostate brachytherapy with MRI-classified Median lobe hyperplasia[J]. Jcb, 2021: 254-262. DOI: 10.5114/jcb.2021.105944.
[50]	Bae HJ, Mian O, Vaidya D, et al. Use of 5-alpha-reductase inhibitors as alternatives to luteinizing-hormone releasing hormone (LHRH) analogs or anti-androgens for prostate downsizing before brachytherapy[J]. Pract Radiat Oncol, 2018, 8(3): e159-e165. DOI: 10.1016/j.prro.2017.10.004.

Please choose a citation manager

Content to export