Background/Objectives: The objective of this study was to evaluate the oncological outcomes and safety of nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) when applied without Prostate Imaging-Reporting and Data System (PI-RADS) ≥3 lesions or Gleason pattern ≥4 on biopsy in the peripheral zone (PZ). Methods: We retrospectively analyzed 208 patients who underwent RARP between August 2017 and December 2022, excluding those who had received preoperative hormonal therapy. After NS status stratification and patient characteristic adjustment using propensity score matching (PSM), positive resection margin (RM) rates and prostate-specific antigen (PSA) recurrence-free survival were compared. Urinary and sexual quality of life (QOL) were assessed using the Expanded Prostate Cancer Index Composite, along with predictive factors associated with positive RM and RM locations in the NS group. Results: NS was performed in 68.6% (n = 129) patients. After PSM, there were no significant differences in RM positivity (p = 0.811) or PSA recurrence-free survival (Log-rank p = 0.79), regardless of NS status. There was no difference in sexual function between groups, but urinary QOL was significantly better in the NS group from the third month onward. In the NS group, RM positivity was 27.9% (n = 36), and diagnostic PSA (odds ratio [OR], 1.110, p = 0.038) and clinical T stage (OR, 1.400, p = 0.038) were predictive factors. The RM positivity rate on the NS side was 10.8%. Conclusions: NS, based on the absence of PI-RADS ≥3 lesions or Gleason pattern ≥4 in PZ, did not increase RM positivity rate and increased early urinary QOL.

Introduction: Tacrolimus exposure varies early after kidney transplantation, and perioperative factors may complicate therapeutic drug monitoring. Fentanyl is commonly used perioperatively, but its association with dose-normalized tacrolimus exposure is unclear. Project Aims or Questions: This study evaluated whether early perioperative fentanyl exposure was associated with dose-normalized tacrolimus exposure during the first week after kidney transplantation. Design: This single-center retrospective program evaluation included 43 adult living-donor kidney transplant recipients who received perioperative fentanyl and had evaluable tacrolimus trough concentrations and corresponding oral daily doses. Cumulative fentanyl dose was the conventional exposure measure; body surface area-normalized and patient-controlled analgesia-administered volume measures were exploratory. The outcome was the log-transformed tacrolimus trough concentration divided by the daily tacrolimus dose. Repeated measurements were analyzed using linear mixed models adjusted for clinical covariates. Results: The conventional cumulative fentanyl dose through postoperative day 1 was associated with 22.7% higher dose-normalized tacrolimus exposure per 1 standard deviation increase, 95% confidence interval 4.4% to 44.1%, P = .013. In exploratory analyses, body surface area-normalized cumulative exposure through postoperative day 1 had the strongest association, a 24.9% increase, 95% confidence interval 7.3% to 45.4%, P = .004. Exposure through postoperative day 2 showed weaker, nonsignificant associations. Conclusion: Early perioperative fentanyl exposure, particularly cumulative exposure through postoperative day 1, was associated with higher dose-normalized tacrolimus exposure during the first postoperative week after kidney transplantation. These findings support contextual interpretation of early tacrolimus monitoring while recognizing confounding by clinical status and the exploratory nature of body surface area-normalized findings.

Enhydrin, a melampolide-type sesquiterpene lactone abundant in the leaves of yacon (Smallanthus sonchifolius), has not previously been investigated for its anti-prostate cancer activity. This study investigated the antiproliferative effects of enhydrin in human prostate cancer cells, its regulatory effects on apoptosis-related molecules, and its impact on the PI3K/AKT and NF-κB signaling pathways. Three prostate cancer cell lines (PC3, DU145, and LNCaP) were treated with enhydrin, and its effects were analyzed using cell viability assays, morphological observation, flow cytometry, apoptosis-focused TaqMan qPCR array, qRT-PCR, and Western blotting. In vivo antitumor activity was assessed in a PC3 xenograft mouse model. Enhydrin reduced cell viability in a dose- and time-dependent manner, induced morphological changes associated with cytotoxicity, and caused G1 cell-cycle arrest. Gene expression analysis revealed downregulation of PI3K/AKT- and NF-κB-related genes and modulation of BCL2 family genes toward a pro-apoptotic profile, which was confirmed at both mRNA and protein levels. In vivo, enhydrin suppressed tumor growth without significant body-weight loss. These findings suggest that enhydrin exerts antitumor effects in prostate cancer by reducing the expression of PI3K/AKT and NF-κB related molecules and modulating apoptosis-related proteins. Although additional studies are required to determine pathway activity, directly confirm apoptosis, and evaluate normal-cell cytotoxicity and the therapeutic window, these findings provide preliminary biological evidence of the effects of enhydrin in prostate cancer models.