Clinical Research Directory

Spatial Multi-Omics of Perineural Invasion Microenvironment and Prognosis in Prostate Cancer

Prostate cancer is a common malignancy in men, with substantial prognostic heterogeneity that calls for improved risk stratification at the tissue microenvironment level. Perineural invasion (PNI) is a frequent pathological feature in prostate cancer, associated with local aggressiveness and postoperative recurrence; however, its microenvironmental characteristics and prognostic value remain incompletely characterized. This study plans to enroll approximately 120 prostate cancer patients, collecting tissue specimens and clinicopathological data. We will integrate HE/WSI pathological images, Xenium spatial transcriptomics, PhenoCycler-Fusion spatial proteomics, whole-exome sequencing, and single-cell transcriptomics to systematically compare PNI-positive regions, PNI-negative tumor regions, and adjacent-normal regions in terms of cellular composition, spatial proximity relationships, molecular pathway activities, and genomic alterations. The objectives are to screen candidate molecular markers associated with PNI burden, local invasion, and poor postoperative outcomes, and to explore the establishment of a PNI classification and prognostic risk assessment model based on spatial multi-omics features, thereby providing a foundation for individualized risk stratification and further mechanistic studies in prostate cancer.

Intratumoral Microbiota and Immune Microenvironment in Prostate Cancer

Prostate cancer is a common malignancy in men, with rising incidence worldwide. Current clinical risk assessment tools-including PSA, Gleason score/ISUP grade, pathological stage, margin status, perineural invasion, and postoperative PSA kinetics-cannot fully explain the marked heterogeneity in disease progression, recurrence, and treatment response, highlighting the need for novel microenvironment-based biomarkers. Emerging evidence has identified intratumoral microbiota as a component of the tumor microenvironment in various solid tumors (e.g., breast, lung, ovarian, pancreatic, and melanoma), where microbial signals correlate with immune infiltration, inflammation, drug metabolism, and patient outcomes. However, the composition, spatial distribution, and immune-related roles of intratumoral microbiota in prostate cancer remain poorly characterized. Given that prostatic tissue resides at the urogenital junction and is continuously exposed to urine, prostatic fluid, and local inflammation, it is plausible that microbial components influence local immunity and tumor behavior. Importantly, intratumoral microbiota represent low-biomass samples, highly susceptible to contamination from reagents, environment, and laboratory procedures. Therefore, this study incorporates rigorous quality controls-including negative controls, process blanks, batch records, contaminant identification, spatial localization validation, and cross-platform verification-to ensure data reliability. Using residual tissue specimens, archived pathological slides, and comprehensive clinicopathological data from prostate cancer patients, we will employ 16S rRNA sequencing, metagenomic/metatranscriptomic sequencing, spatial transcriptomics, spatial proteomics, immunofluorescence, immunohistochemistry, and bioinformatic analyses to profile intratumoral microbiota. Our specific objectives are: (1) to compare microbial composition, abundance, and diversity among tumor, adjacent-normal, and benign tissues; (2) to validate spatial localization of candidate microbial signals via in situ hybridization, immunohistochemistry, and spatial omics; (3) to assess differences in immune cell infiltration, macrophage polarization, T-cell exhaustion markers, and inflammatory pathways between microbe-high and microbe-cold regions; (4) to explore associations between microbial features and Gleason score/ISUP grade, stage, perineural invasion, margin status, postoperative PSA changes, biochemical recurrence, and other clinical outcomes; and (5) to establish a standardized workflow for low-biomass intratumoral microbiome research in prostate cancer. This study aims to provide new insights into microenvironmental heterogeneity and to lay a foundation for identifying prognostic biomarkers and potential therapeutic targets.

Prostate Oncologic Therapy While Ensuring Neurovascular Conservation (POTEN-C)

Reduction of dose to or 'sparing' of neurovascular structures during stereotactic ablative body radiotherapy (SAbR) for localized prostate cancer will improve retention of sexual potency, while retaining excellent oncologic control and other secondary health-related quality of life (HRQOL) endpoints. Primary Objectives: • To compare the decline in patient health-related quality of life (HRQOL) instrument-defined erectile dysfunction following stereotactic ablative body radiotherapy (SAbR) with or without neurovascular sparing Secondary Objectives: * Assess acute (within 3 months of treatment) and chronic (\>3 months after treatment) SAbR related GU and GI toxicities, as well as serial impact on HRQOL metrics over time * Assess biochemical progression free survival, local recurrence, distant recurrence, and survival * Evaluate simplified 'practical' secondary HRQOL sexual potency endpoints that can be compared to prior literature. Exploratory Objectives: * Evaluate feasibility of MRI BOLD/TOLD to be integrated as hypoxia monitoring sequences to standard already planned diagnostic and/or treatment planning MRI on the study in five patient pilot. * Evaluate quality of spacer placement and its effect on dose to neurovascular structures * Evaluate rate local recurrence in the area of sparing adjacent to the neurovascular elements by biopsy in those with biochemical progression.

Multi-omics Analysis of Prostate Derived Extracellular Vesicles: an Observational Retrospective Study for Prostate Cancer Diagnosis and Monitoring

Prostate cancer (PCa) is the most commonly diagnosed malignancy in men and a leading cause of cancer-related mortality worldwide. Over 1.4 million new cases of prostate cancer are estimated to occur worldwide each year, with more than 375,000 related deaths. High-risk PCa poses significant challenges due to the aggressive nature of the disease and the ability to create an immunosuppressive tumor microenvironment (TME), thereby hampering the effectiveness of existing therapies. Despite advances in diagnostics and treatment, the mechanisms driving immune evasion and tumor progression in high-risk PCa remain poorly understood. These considerations underscore the urgent need for innovative strategies to address these challenges and improve patient outcomes. Extracellular vesicles (EVs) have emerged as critical players in cancer biology. EVs carry molecular cargo, including proteins, RNA, lipids, and metabolites, enabling mediation of intercellular communication and influence on cancer progression. Tumor-derived EVs (TDEVs) are particularly implicated in promoting tumor growth, reprogramming the TME, and suppressing antitumor immune responses. Owing to the intrinsic ability to mediate intercellular communication and transport biomolecules to distant sites, EVs represent key contributors to cancer pathogenesis. A previous study demonstrated, through comprehensive metabolomics profiling, a combination of small molecules extracted from expressed prostatic secretion (EPS)-urine, integrated with clinical parameters, that could effectively identify and stratify PCa patients, highlighting the potential of this biofluid in PCa diagnostics. EPS-urine represents a unique biofluid enriched with EVs secreted directly by prostate tissue, offering a valuable source for the study of prostate-specific EVs. Based on this evidence, the potential of prostate cancer (PCa)-derived EVs is being explored as a transformative approach for the management of high-risk prostate cancer. The project qualifies as a basic research study with potential translational relevance. An observational retrospective study has been designed with the objective of comprehensively characterizing extracellular vesicles (EVs) derived from EPS-urine using multi-omics approaches. The analysis will be conducted on samples from 100 patients, all recruited exclusively at the Department of Urology at IRCCS San Raffaele Hospital. Patients are categorized into two groups: patients with clinically significant prostate cancer (csPCa), including intermediate-risk PCa (ISUP grade 2-3) and high-risk PCa (ISUP grade 4-5), and patients with non-clinically significant PCa (non-csPCa), including low-risk PCa (ISUP grade 1) and patients with benign prostatic hypertrophy. The study is expected to provide unprecedented insights into prostate tissue-derived EVs, laying the foundation for functional validation of key molecular markers and pathways implicated in PCa progression.

Safety and Efficacy Evaluation of LC-K76 in Patients With Metastatic Hormone-Sensitive Prostate Cancer

This study is a single-centre, randomised, paired 24-week intervention dosing trial. Its purpose is to evaluate the safety profile and efficacy of the investigational drug in subjects with metastatic hormone-sensitive prostate cancer receiving oral LC-K76 treatment. Following a screening period not exceeding three weeks, subjects will enter a one- to two-week matching and randomization phase. Subsequently, subjects will be assigned to receive the study drug for a 24-week treatment period, followed by a 24-week follow-up period.

Prostatic Size Reduction Following of Leuprorelin Acetate

To determine the possible reduction in prostate size following the administration of Leuprelin prior to the application of radiotherapy.