Intermediate-risk prostate cancer (IR PCa) is the most common risk group for localized prostate cancer. This study aimed to develop a machine learning (ML) model that utilizes biopsy predictors to estimate the probability of IR PCa and assess its performance compared to the traditional clinical model.

Between January 2017 and December 2022, patients with prostate-specific antigen (PSA) values of ≤ 20 ng/mL underwent transrectal ultrasonography-guided prostate biopsies. Patient's age, PSA, digital rectal exam, prostate volume, PSA density (PSAD), and previous negative biopsy, number of positive cores, Gleason score, and biopsy outcome were recorded. Patients are categorized into no cancer, very low, low-, and intermediate-risk categories. The relationship between the model and IR PCa was investigated using binary generalized linear model (GLM) and assessed its discriminatory ability by calculating the area under the receiver operating characteristic curve (AUC).

Among 729 patients, PCa was detected in 234 individuals (32.1%), with 120 (16.5%) diagnosed with IR PCa. The AUC for the novel model compared to the clinical model was 0.806 (95% CI: 0.722-0.889) versus 0.669 (95% CI: 0.543-0.790), with a p-value of 0.018. In DCA, the GLM outperformed the clinical model by over 7%, potentially allowing for an additional 44.3% reduction in unnecessary biopsies. The PSAD emerged as the most significant predictor.

We developed a GLM utilizing pre-biopsy features to predict IR PCa. The model demonstrated good discrimination and clinical applicability, which could assist urologists in determining the necessity of a prostate biopsy.

Traditional ultrasonography-based prostate biopsy uses a transrectal approach for systematic sampling of 12 cores. The magnetic resonance imaging (MRI) fusion biopsy uses a targeted approach, first identifying regions of interest (ROI) clinically suspicious for prostate cancer (PCa) through MRI, before performing a prostate biopsy aided by ultrasonography.

The single-center institutional retrospective cohort study used 442 men who were recommended for localized PCa management. Cohort A (n = 346) comprised patients who underwent MRI-guided TRUS biopsies, which included both standard 12-core TRUS biopsies and MRI-targeted biopsies performed simultaneously. Cohort B (n = 96) comprised patients who received only standard TRUS biopsy. The primary endpoint was Gleason reclassification, defined as the change in Gleason scores between standard TRUS and targeted region-of-interest (ROI) biopsies among cohort A. Secondary endpoint assessed the role of ROI biopsies in mitigating overtreatment by analyzing the probability of undergoing treatment and the duration of active surveillance (AS).

Among men classified as no tumor on standard biopsy, 16.9 % showed Gleason disease on subsequent ROI biopsy. Additionally, ROI group also had a longer time to receive primary treatment (P = .017), as they were more likely to opt for AS (54 %). Lastly, median time spent on AS was longer for the ROI group compared with the non-ROI cohort (P = .002).

Adding multiparametric MRI (mpMRI) biopsy to standard TRUS biopsy may increase the detection of PCa. Additionally, mpMRI may allow patients to remain safely on AS, thereby reducing the need of prostate biopsies and improving cost-effectiveness.

Genomic testing can add risk stratification information to clinicopathological features in prostate cancer, aiding in shared medical decision-making between the clinician and patient regarding whether active surveillance (AS) or definitive treatment (DT) is most appropriate. Here we examined initial AS selection and 3-year AS durability in patients diagnosed with localized intermediate-risk prostate cancer who underwent Prolaris testing before treatment decision-making.

This retrospective observational cohort study included 3208 patients from 10 study sites who underwent Prolaris testing at diagnosis from September 2015 to December 2018. Prolaris utilizes a combined clinical cell cycle risk score calculated at diagnostic biopsy to stratify patients by the Prolaris AS threshold (below threshold, patient recommended to AS or above threshold, patient recommended to DT). AS selection rates and 3-year AS durability were compared in patients recommended to AS or DT by Prolaris testing. Univariable and multivariable logistic regression models and Cox proportional hazard models were used with molecular and clinical variables as predictors of initial treatment decision and AS durability, respectively.

AS selection was ~2 times higher in patients recommended to AS by Prolaris testing than in those recommended to DT (p < 0.0001). Three-year AS durability was ~1.5 times higher in patients recommended to AS by Prolaris testing than in those recommended to DT (p < 0.0001). Prolaris treatment recommendation remained a statistically significant predictor of initial AS selection and AS durability after accounting for CAPRA or Gleason scores.

Prolaris added significant information to clinical risk stratification to aid in treatment decision making. Intermediate-risk prostate cancer patients who were recommended to AS by Prolaris were more likely to initially pursue AS and were more likely to remain on AS at 3 years post-diagnosis than patients recommended to DT.

Adverse pathological features in prostate cancer (PCa) are characteristics found in biopsy tissue that indicate a more aggressive or advanced disease. This study aims to develop a biopsy-based model for assessing the risk of adverse PCa and to evaluate its performance against the European Randomized Study of Screening for Prostate Cancer (ERSPC) Risk Calculator (RC) 3/4 and PSA models.

Between January 2017 and December 2022, patients with prostate-specific antigen (PSA) levels of ≤ 50 ng/mL underwent prostate biopsies. The patients' age, PSA, digital rectal exam, prostate volume, PSA density (PSAD), previous negative biopsy, number of positive cores, Gleason score, and biopsy outcomes were documented. Patients were classified into categories: no cancer, very low-risk, low-risk, intermediate-risk, and high-risk groups. We investigated the relationship between our model and adverse PCa using a binary Generalized Linear Model (GLM). We evaluated the model's discriminatory ability using the area under the receiver operating characteristic curve (AUC) and compared its predictive performance with the adverse model in terms of discrimination, calibration, and clinical utility.

Out of 824 patients, PCa was diagnosed in 320 (38.8%) men, and 203 (24.6%) had unfavorable PCa. The GLM demonstrated improved performance metrics, with an AUC of 0.766, compared to 0.639 for the RC 3/4 model and 0.655 for the PSA model. The GLM showed a good fit and provided a greater net benefit.

The study identified clinical predictors of adverse PCa during biopsy, demonstrating moderate discrimination and clinical utility. Further large multicenter studies are required for validation.

Approximately 50% of prostate cancer (PCa) patients meet the National Comprehensive Cancer Network (NCCN) guidelines for germline testing at diagnosis. However, the selection of genes for testing, their supporting evidence, and clinical interpretation remain poorly understood.

An evidence-based evaluation of the recommended genes was conducted using data from the UK Biobank and Johns Hopkins School of Medicine, including 22,052 PCa patients and 191,055 unaffected controls. Association of germline pathogenic/likely pathogenic (P/LP) variants in each gene was tested using logistic regression, adjusting for age and genetic background.

Among the 11 NCCN-recommended PCa-related genes, significant associations (p < 0.0045) were identified between germline P/LP variants of five genes (HOXB13, BRCA2, ATM, CHEK2, and MSH2) and PCa risk. Additionally, BRCA2 and ATM variants were significantly associated with PCa aggressiveness. Of the 19 NCCN-recommended genes related to PARPi sensitivity, consistent evidence supported an enhanced response to PARPi therapy in patients with BRCA2 alterations, with weaker evidence for BRCA1, and limited supporting evidence for the remaining genes. Germline P/LP variants in BRCA2 and BRCA1 were observed in 0.77% and 0.14% of unselected PCa patients, respectively. Notably, no published study specifically assessed the efficacy of germline alterations, which were considerably rarer than somatic mutations.

Supporting statistical evidence is available for only a subset of the NCCN-recommended genes for germline testing. This evidence-based analysis may aid urologists-particularly those without specialized genetics training-in understanding germline testing for PCa risk assessment, prognosis, and treatment decision-making in clinical practice.

The currently available clinical anticancer approaches pertaining to the treatment of prostate cancer are summarized here. After providing an overview of the main features of this highly impactful global disease, the currently available clinical treatments are briefly reviewed. Then, alternative and innovative nano-based therapeutic options that have been proposed or are currently being explored to significantly improve prostate cancer management (i.e. anti-prostate cancer polymeric nanoparticles loaded with drugs to promote their release and biological activity, including non-targeted and functionalized PLGA-PEG NPs and AuNPs), are introduced. Furthermore, the problem of gathering insights into the mechanistic aspects related to the fate of the nanoformulation in complex matrices, such as blood plasma, is addressed.

Genetic predisposition is identified in 5-10% of prostate cancer patients. Although genetic testing is more frequently proposed, international recommendations are lacking. This study evaluates the impact of germline analysis on management of prostate cancer patients. Retrospective descriptive data were collected from prostate cancer patients who attended oncogenetic counselling between 2018 and 2021. Data included clinical and tumoral characteristics, and genomic analysis. Comparative analysis was performed between patients with germline pathogenic variants (PVs) and non-carriers using non-parametric tests. Fourteen out of the 168 patients (8.3%) had a PV, primarily in DNA repair genes (N = 13/14), including BRCA1/2 (N = 5). Twenty-five patients (14.9%) had variants of undetermined significance. Patients with PVs were more likely to have synchronous metastatic extension (79% vs 43%, p = 0.02) and a Gleason score ≥8 (82% vs 53%, p = 0.11). Significant enrichment of ATM PVs compared to a healthy control cohort was observed with an odds ratio of 32.5 [15.8-67.0] (p < 0.05). Three of five patients with BRCA1/2 PVs received DNA repair-targeted treatment. This cohort provides insights into the impact of oncogenetic counselling on prostate cancer patients' management. It highlights the need to refine referral criteria based on disease stage and Gleason score and to further investigate ATM PVs. The data also underscore the importance of developing a care pathway with clear criteria for germline and/or somatic analysis to improve theranostic outcomes.

This study investigates the association between thromboembolic events (TE) and castration-resistant prostate cancer (CRPC) patients receiving oral androgen receptor pathway inhibitors (ARPi) compared to those undergoing chemotherapy, both with and without a pre-existing history of cardiovascular disease (CVD).

A total of 2779 men diagnosed with CRPC were identified using the Surveillance, Epidemiology, and End Results (SEER) Medicare Linked Database from 2012 to 2016. Patients were stratified based on their CVD history. Within each CVD stratum (pre-existing CVD vs. no pre-existing CVD), patients were further categorized into two treatment groups: those receiving oral ARPi and those undergoing chemotherapy. Unadjusted and inverse probability treatment weight (IPTW)-adjusted proportional hazards models, using Fine and Gray's method, were applied to evaluate the potential association between ARPi treatment and TE.

Patients with pre-existing CVD treated with ARPi exhibited a significantly lower crude hazard ratio (HR) for TE compared to chemotherapy (HR 0.39, 95% CI 0.27-0.58, p < 0.001). However, after adjustment using IPTW, this association was no longer significant (adjusted hazard ratio [AHR] 1.00, 95% CI 0.75-1.32, p = 0.99). For patients without CVD, ARPi use was also associated with a reduced risk of TE in the crude analysis (HR 0.53, 95% CI 0.32-0.87, p = 0.01), but this effect was not statistically significant after IPTW adjustment (HR 0.99, 95% CI 0.69-1.41, p = 0.94).

ARPi demonstrated no significant effect on TE risk compared to chemotherapy, regardless of pre-existing CVD status. Similarly, when excluding patients with a prior history of TE, ARPi use remained non-significantly associated with new TE in the IPTW-adjusted competing risk analysis, highlighting the need for further investigation.

Focal therapy (FT) is an emerging strategy for selectively ablating prostate cancer (PCa). However, existing challenges comprise conventional techniques inadequately identifying appropriate candidates and insufficient characterization of multifocality and sampling-biases in the biopsy-based trials. We evaluated the value of adding prostate-specific membrane antigen (PSMA) and gastrin-releasing peptide receptors (GRPR) PET to multiparametric MRI (PET/mpMRI) in preoperative assessments for FT, with whole-mount pathology as a comprehensive reference.

A total of 38 men with biopsy-proven low-risk/intermediate-risk PCa underwent mpMRI, 68Ga-PSMA, and 68Ga-RM26 PET. Any focal lesion uptake (PETFL) was considered for positive PET results, while PI-RADS for mpMRI interpretation. Index lesion was defined with the highest Gleason score or largest diameter. Detection rates for clinically significant (cs) PCa (lesion-level) and diagnostic performances for localization (segment-level) were assessed. Correct identification of FT-ineligible men (index lesion Grade Group>3 or contralateral csPCa) was documented.

For detecting the overall 73 csPCa, both 68Ga-PSMA and 68Ga-RM26 PET/mpMRI demonstrated significantly higher detection rates (87.7% and 94.5% vs. 72.6%, P<0.005), as well as higher accuracies for localization (0.87 and 0.90 vs. 0.81, P<0.001) than mpMRI alone. Twenty of 38 (53%) men were confirmed FT-ineligible, of which mpMRI, 68Ga-PSMA, and 68Ga-RM26 PET/mpMRI identified 12 (60%), 20 (100%) and 17 (85%), respectively. Finally, 68Ga-PSMA and 68Ga-RM26 PET/mpMRI identified csPCa lesions in 88.5% and 100% of FT-eligible men, respectively.

Combining PSMA/GRPR PET and mpMRI facilitates enhanced detection rates as well as higher accuracies for localization in localized PCa. 68Ga-PSMA and 68Ga-RM26 PET/mpMRI may serve as promising imaging tools to improve the preoperative assessments in FT candidates with low-risk/intermediate-risk PCa.

This study aimed to develop an explainable radiomics model for stratifying prostate cancer (PCa) patients with high-risk disease via investigation of the association between cell density (CD) in the PCa region on histopathological images and multiparametric MR (mpMR) radiomics features.

137,970 radiomic features were calculated from mpMR images (101 PCa regions of 44 patients), and joint histograms (JHs) were derived from dynamic contrast-enhanced (DCE) images for each PCa region. The association between CD on histopathological images and its corresponding mpMR radiomic features in PCa regions for various grade groups and the three risk groups was evaluated using Spearman's correlation coefficient. To validate the potential of the radiomic-feature-CD association, we developed the radiomics model for stratifying patients into low/intermediate-risk and high-risk groups.

There were moderate correlations of the CD with a DCE-based texture feature (WV_HH_1st_GLSZM_ZP) (ρ = 0.609, p = 0.024) and DCE-JH feature (JH_WV_HL_1st versus 5th-1st_Hist_STD) (ρ = 0.609, p = 0.024) in the high-risk group. The radiomics model had an accuracy of 0.920 for stratifying the patients of a test dataset into the low/intermediate-risk and high-risk groups.

The association between CD and mpMR features can be leveraged to develop the explainable radiomics for the high-risk stratification of patients with PCa.

Introduction: Cannabis sativa extract has been used as an herbal medicine since ancient times. It is one of the most researched extracts, especially among supportive treatments against cancer. Prostate cancer is one of the most frequently diagnosed cancer types in men worldwide and an estimated 288,300 new cases were diagnosed in 2023. Today, many advanced therapeutic approaches are used for prostate cancer, such as immunotherapy and chemotherapy, but acquired drug resistance, long-term drug usage and differentiation of cancer cells mostly restricted the efficiency of therapies. Therefore, it is thought that the use of natural products to overcome these limitations and improve the effectiveness of existing therapies may offer promising approaches. The present study focused on the investigation of the possible enhancer role of cannabidiol (CBD), which is a potent ingredient compound of Cannabis, on the chemotherapeutic agent etoposide in prostate cancer cells. Methods: Herein, we tested the potentiator role of CBD on etoposide in prostate cancer cells by testing the cytotoxic effect, morphological alterations, apoptotic effects, autophagy, unfolded protein response (UPR) signaling, endoplasmic reticulum-associated degradation mechanism (ERAD), angiogenic and androgenic factors, and epithelial-mesenchymal transition (EMT). In addition, we examined the combined treatment of CBD and etoposide on colonial growth, migrative, invasive capability, 3D tumor formation, and cellular senescence. Results: Our findings demonstrated that cotreatment of etoposide with CBD importantly suppressed autophagic flux and induced ERAD and UPR signaling in LNCaP cells. Also, CBD strongly enhanced the etoposide-mediated suppression of androgenic signaling, angiogenic factor VEGF-A, protooncogene c-Myc, EMT, and also induced apoptosis through activation caspase-3 and PARP-1. Moreover, coadministration markedly decreased tumorigenic properties, such as proliferative capacity, colonial growth, migration, and 3D tumor formation and also induced senescence. Altogether, our data revealed that CBD has a potent enhancer effect on etoposide-associated anticancer activities. Conclusion: The present study suggests that the use of CBD as a supportive therapy in existing chemotherapeutic approaches may be a promising option, but this effectiveness needs to be investigated on a large scale.

Implications of relabeling Grade Group 1 prostate cancer as noncancer will depend on the recommended active surveillance strategy. Whether relabeling should prompt deintensifying, prostate-specific antigen (PSA)-based active monitoring approaches is unclear. We investigated outcomes of biopsy-based active surveillance strategies vs PSA-based active monitoring for Grade Group 1 diagnoses under different patient adherence rates.

We analyzed longitudinal PSA levels and time to Grade Group 2 or higher reclassification among 850 patients with a diagnosis of Grade Group 1 disease from the Canary Prostate Active Surveillance Study (2008-2013). We then simulated 20 000 patients over 12 years, comparing Grade Group 2 or higher detection under biennial biopsy against 3 PSA-based strategies: (1) PSA (biopsy for PSA change ≥20% per year), (2) PSA plus magnetic resonance imaging (magnetic resonance imaging for PSA change ≥20% per year and biopsy for Prostate Imaging Reporting & Data System ≥3), and (3) predicted risk (biopsy for predicted upgrading risk ≥10%).

Under biennial biopsies and 20% dropout to active treatment, 17% of patients had a 2-year or longer delay in Grade Group 2 or higher detection. The PSA strategy reduced the number of biopsies by 39% but delayed detection in 32% of patients. The PSA plus magnetic resonance imaging strategy reduced the number of biopsies by 52%, with a 34% delay. The predicted risk strategy reduced the number of biopsies by 31%, with only an 8% delay. These findings are robust to biopsy sensitivity and confirmatory biopsy.

Prostate-specific antigen-based active monitoring could substantially reduce biopsy frequency; however, a precision strategy based on an individual upgrading risk is most likely to minimize delays in detection of disease progression. This strategy may be preferred if active surveillance is deintensified under relabeling, provided patient adherence remains unaffected.

Briganti and Memorial Sloan-Kettering Cancer Centre (MSKCC) nomograms are the two commonly used models for predicting lymph node invasion (LNI) in patients with prostate cancer. However, they have never been validated in the Indian cohort of patients with prostate cancer. Hence, with this study, we aimed to externally validate Briganti (2012) and MSKCC nomograms in our dataset of patients who underwent robot-assisted radical prostatectomy (RARP). We reviewed our prospectively maintained RARP data to predict the probability of LNI using Briganti (2012) and MSKCC nomograms. The two models were validated by receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA). Of the 482 patients included in this study, 127 (26.3%) had lymph nodal metastasis. ROC analysis revealed an area under the curve of 0.75 (0.70-0.80) and 0.76 (0.71-0.80) for the Briganti and MSKCC nomograms, respectively, in predicting LNI. Calibration plots for both Briganti and MSKCC nomograms showed under or overestimation at different predicted probabilities. DCA showed a net clinical benefit of both models at a threshold probability of 10%. Using 5% cut-off for threshold for lymph node dissection, Briganti nomogram would have sensitivity, specificity, PPV, and NPV of (126/127) 99.2%, (14/355) 3.9%, (126/467) 26.9%, and (14/15) 93.3%, respectively. Using the same cut-off, MSKCC nomogram would have sensitivity, specificity, PPV, and NPV of (126/127) 99.2%, (56/355) 15.7%, (126/425) 29%, and (56/57) 98%, respectively. With this study, we independently validated Briganti and MSKCC nomograms for predicting LNI in the Indian cohort of patients with prostate cancer.

Boennuokang® leuprorelin acetate microspheres show a certain efficacy in patients with prostate cancer, but its utilization as neoadjuvant therapy in patients with high-risk prostate cancer remains unclear. Hence, this real-world study investigated the efficacy and safety of Boennuokang® leuprorelin acetate microspheres-based treatment as neoadjuvant therapy in patients with high-risk prostate cancer.

This retrospective study included 53 patients with high-risk prostate cancer who received Boennuokang® leuprorelin acetate microspheres as neoadjuvant therapy and laparoscopic radical prostatectomy.

The median prostate-specific antigen (PSA) was 34.1 ng/mL before neoadjuvant therapy and reduced to 0.8 ng/mL after neoadjuvant therapy (P<0.001). Testosterone showed a decreased tendency after neoadjuvant therapy, but without statistical significance (P=0.185). After surgery, 36 (67.9%) patients had negative surgical margin. The median (interquartile range) prostate volume reduced from 40.5 (33.4-55.2) mL before neoadjuvant therapy to 30.2 (25.2-40.2) mL after neoadjuvant therapy (P<0.001). Meanwhile, alkaline phosphatase before neoadjuvant therapy, at one month (M1), 3 months (M3), 6 months (M6), and 12 months (M12) after surgery tended to be increased (P=0.029), but this increment lacks clinical significance, while the glomerular filtration rate (P=0.441) and albumin (P=0.548) did not vary among different time points. Erectile dysfunction and loss of libido was the most common adverse event, with incidences of 84.9% during neoadjuvant therapy, 79.2% at M1, 71.7% at M3, 67.9% at M6, and 56.6% at M12.

Boennuokang® leuprorelin acetate microspheres-based treatment as neoadjuvant therapy decreases PSA, testosterone, and prostate volume, with acceptable positive surgical margin rate in patients with high-risk prostate cancer and its safety profiles should be validated.

Interdisciplinary tumor boards (ITB) are essential in optimizing treatment recommendations for metastatic castration-resistant prostate cancer (mCRPC) by incorporating oncology guidelines, clinical trials, and patient-specific factors to ensure individualized care. This study examines clinical parameters that influence ITB recommendations, evaluates their adherence to guidelines, and assesses their impact on patient survival.

In a retrospective analysis, data from 187 mCRPC patients discussed at an ITB in a tertiary care center in 2018 were evaluated. Patient- and disease-specific factors were correlated with adherence to National Comprehensive Cancer Network® (NCCN®) guidelines and overall survival (OS). The impact of clinical parameters on survival outcomes was assessed through univariate and multivariate analyses.

The median patient age was 72.8 years, with a median prostate-specific antigen (PSA) level of 65.0 ng/ml. Guideline-compliant recommendations were given in 42.9% of cases, while 57.1% received individualized recommendations. Clinical trial eligibility was noted in 24.8% of patients. Individualized ITB recommendations were associated with significantly longer OS (38.3 vs. 21.2 months, p = 0.03). Shorter OS correlated with renal impairment (p = 0.007), symptomatic metastases (p < 0.0001), and visceral metastases (p < 0.0001). Limitations include the retrospective design, lack of follow-up on therapy adherence, and absence of progression-free survival (PFS) data.

ITB discussions improve survival in mCRPC patients, mainly due to personalized approaches and better access to clinical trials. Visceral and symptomatic metastases as well as renal impairment are risk factors for reduced OS, emphasizing the need for careful management of these high-risk patients. The results support the expanded use of ITB to improve mCRPC treatment outcomes.

To assess the clinical value of [18F]F-PSMA negative PET/CT, in patients diagnosed with prostate cancer treated with prostatectomy with elevated PSA less than 1 ng/mL, on the outcome of salvage radiotherapy.

We prospectively included 98 patients diagnosed with prostate cancer treated with prostatectomy with biochemical recurrence [mean PSA 0.51 ng/mL (range 0.17-1.0 ng/mL)] who were referred for an [18F]F-PSMA -PET/CT study. The [18F]F-PSMA -PET/CT scan was negative in 53/98 patients (54.09%). Differences were analysed between those patients who were or were not candidates for pelvic salvage radiotherapy (PSRT) decided upon multidisciplinary committee and patient consent, with a minimum follow-up time for 1 year. Response to treatment was defined as a 50% reduction in PSA levels. Recurrence was ascertained upon clinical, analytical and imaging follow-up outcomes.

54.7% (29/53) of the patients with a negative [18F]F-PSMA -PET/CT underwent PSRT. Of these, 93.1% (27/29) patients demonstrated response to treatment (PSMA false negatives). The remaining two patients showed fluctuating PSA levels without detecting disease on the [18F]F-PSMA -PET/CT follow-up study. 45.3% (24/53) of patients with negative [18F]F-PSMA -PET/CT did not undergo PSRT. Of these, progressive PSA elevation was observed in 62.5% (15/24) (PSMA false negatives), localising recurrence on the [18F]F-PSMA -PET/CT follow-up study in 4 patients. The remaining 9 patients (37.5%) showed fluctuating PSA levels without detecting disease on the [18F]F-PSMA -PET/CT follow-up study. Our series confirmed 42 (42.85%) [18F]F-PSMA -PET/CT false negatives cases.

Patients diagnosed with prostate cancer with post-prostatectomy biochemical recurrence and a negative [18F]F-PSMA -PET/CT study are likely to benefit from pelvic salvage radiotherapy, with response seen in 93.1% of our cases.

Local recurrence of prostate cancer (PCa) after radiation therapy (RT) typically occurs at the site of dominant tumor burden, and recent evidence confirms that magnetic resonance imaging (MRI) guided tumor dose escalation improves outcomes. With the emergence of prostate-specific membrane antigen (PSMA) positron emission tomography (PET), we hypothesize that PSMA-PET and MRI may not equally depict the region most at risk of recurrence after RT.

Patients with intermediate- to high-risk PCa and MRI plus PSMA-PET performed before RT were identified. The sextant most at risk of recurrence was defined as the pathologically dominant region with peak biopsy percentage core length involvement and any sextant with ≥ 40% percentage core length involvement (pathologic gross tumor volume [pGTV], per prior work). Imaging methods were reviewed independently to compare GTVs with pGTVs most at risk of recurrence. A paired chi-square test was employed for analysis.

Eighty-eight patients (n = 88) were identified. Overall, there were no differences in the sensitivity of MRI and PSMA-PET for identifying the pGTV most at risk of recurrence. However, PSMA-PET demonstrated a trend of improved sensitivity for high-risk PCa compared with MRI (n = 46, 96% vs 87%, P = .06), while MRI outperformed PSMA-PET for the intermediate-risk group (n = 42, 93% vs 81%, P = .03). PSMA-PET showed lower specificity, misidentifying GTV in uninvolved pathologic sextants for 12% of intermediate-risk patients, whereas MRI was faultless (12% vs 0%, P = .03). MRI and PSMA-PET each misidentified uninvolved sextants for 9% of patients in the high-risk group.

MRI demonstrates superior sensitivity in identifying the region most at risk of RT recurrence for intermediate-risk PCa, whereas PSMA-PET may add value for some high-risk patients. Informed by sextant biopsy information and MRI, clinicians should consider integrating PSMA-PET for patients with high-risk diseases when delineating GTVs.

Prostate cancer (PCa) is the most common malignant tumor that endangers the life and health of middle-aged and elderly men.

To evaluate the significance of radiomic features from intralesional and perilesional regions in bi-parametric magnetic resonance imaging (MRI) for diagnosing PCa.

A total of 211 patients with suspected PCa who accepted prostate MRI scans were enrolled in this study. The region of interest (ROI) corresponding to the original lesion was manually delineated to define the intralesional ROI on bp-MRI maps. The original lesion ROI was then expanded by 2 mm, 4 mm, 6 mm, and 8 mm, while excluding the intralesional area to create the perilesional ROI. Features were extracted from each ROI, and a radiomics model was developed using logistic regression. The combined model integrated features from both intralesional and perilesional regions. Its predictive performance was assessed using receiver operating characteristic (ROC) curves and area under the curve (AUC) to evaluate its diagnostic efficacy for PCa.

The comparison revealed that perilesional 4 mm model had the best performance among all perilesional models, its AUCs of 0.934 and 0.894 in the training testing set, respectively, outperformed the combined model of other regions. The clinical model, combined model for intralesional regions, and INTRAPERI model achieved AUCs of 0.911, 0.925, 0.931 in the training sets and 0.770, 0.867, 0.905 in the testing sets. The predictive performance of the INTRAPERI model is better than the clinical model and intralesional model.

The radiomic model combining intralesional and perilesional features from bi-parametric MRI shows strong predictive value for PCa and may enhance clinical decision-making.

This study introduces an integrated approach using structured and unstructured data from an electronic health record to identify and characterize patient utilization of hereditary cancer genetic testing among patients with metastatic castration-resistant prostate cancer (mCRPC). Secondary objectives were to describe factors associated with the receipt of testing.

This retrospective cohort study included a cohort of Veterans diagnosed with mCRPC from January 2016 to December 2021. Receipt of genetic testing was identified using structured and unstructured data. Time to testing, age at testing, and testing rate were analyzed. Sociodemographic and clinical factors associated with receipt of hereditary cancer genetic testing were identified including race, marital status, rurality, Charlson comorbidity index (CCI), and genetic counseling.

Among 9,703 Veterans with mCRPC who did not decline testing, 16% received genetic testing, with nearly half of the tests occurring in 2020-2021. Factors positively associated with genetic testing included receipt of genetic counseling (adjusted odds ratio [aOR], 11.07 [95% CI, 3.66 to 33.51]), enrollment in clinical trial (aOR, 7.42 [95% CI, 5.59 to 9.84]), and treatment at a Prostate Cancer Foundation-Veterans Affairs Center of Excellence (aOR, 1.43 [95% CI, 1.04 to 1.95]). Negative associations included older age (aOR, 0.95 [95% CI, 0.93 to 0.97]) and severe CCI score (aOR, 0.82 [95% CI, 0.71 to 0.94]). Trends revealed that time to testing decreased per diagnosis year while median age at testing increased per year.

Although testing rates are still suboptimal, they have increased steadily since 2016. Educating Veterans about the benefits of genetic testing may further improve testing rates.

Traditional treatments for localized prostate cancer include radical prostatectomy or radiation therapy but pose challenges due to treatment related side effects, namely erectile dysfunction and urinary incontinence. In recent years, focal therapy has emerged as a viable treatment option for localized low-intermediate risk prostate cancer in carefully selected patients. Short and medium-term studies show acceptable cancer control outcomes and reduced morbidity when comparing focal therapy to whole gland treatment for prostate cancer, however there is paucity of long-term studies. Here we review focal ablative therapies commonly used, discuss the role of imaging in monitoring treatment, and summarize oncologic outcomes based on studies to date.

Background/Objectives: The prognostic value of baseline clinical parameters in predicting the survival prolonging effect of Radium-223-dichloride (223RaCl2) for metastatic castration resistant prostate cancer (mCRPC) patients has been the object of intensive research and remains an open issue. This national multicenter study aimed to corroborate the evidence of ten years of clinical experience with 223RaCl2 by collecting data from eight Italian Nuclear Medicine Units. Methods: Data from 581 consecutive mCRPC patients treated with 223RaCl2 were retrospectively analyzed. Several baseline variables relevant to the overall survival (OS) analysis were considered, including age, previous radical prostatectomy/radiotherapy, number of previous treatment lines, prior chemotherapy, Gleason score, presence of lymphoadenopaties, number of bone metastases, concomitant use of bisphosphonates/Denosumab, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), as well as baseline values of hemoglobin (Hb), platelets, Total Alkaline Phosphatase (tALP), Lactate Dehydrogenase (LDH), and Prostate-Specific Antigen (PSA). Data were summarized using descriptive statistics, univariate analysis and multivariate analysis with the Cox model. Results: The median OS time was 14 months (95%CI 12-17 months). At univariate analysis age, the number of previous treatment lines, number of bone metastases, ECOG-PS, presence of lymphadenopathies at the time of enrollment, as well as baseline tALP, PSA, and Hb, were independently associated with OS. After multivariate analysis, the number of previous treatment lines (HR = 1.1670, CI = 1.0095-1.3491, p = 0.0368), the prior chemotherapy (HR = 0.6461, CI = 0.4372-0.9549, p = 0.0284), the presence of lymphadenopathies (HR = 1.5083, CI = 1.1210-2.0296, p = 0.0066), the number of bone metastases (HR = 0.6990, CI = 0.5416-0.9020, p = 0.0059), ECOG-PS (HR = 1.3551, CI = 1.1238-1.6339, p = 0.0015), and baseline values of tALP (HR = 1.0008, CI = 1.0003-1.0013, p = 0.0016) and PSA (HR = 1.0004, CI = 1.0002-1.0006, p = 0.0005) remained statistically significant. Conclusions: In the era of precision medicine and in the landscape of novel therapies for mCRPC, the prognostic stratification of patients undergoing 223RaCl2 has a fundamental role for clinical decision-making, ranging from treatment choice to optimal sequencing and potential associations. This large Italian multicenter study corroborated the prognostic value of several variables, emerging from ten years of clinical experience with 223RaCl2.

The presence of clinically significant prostate cancer (csPCa) is equivocal for patients with prostate imaging reporting and data system (PI-RADS) category 3. We aim to develop deep learning models for re-stratify risks in PI-RADS category 3 patients.

This retrospective study included a bi-parametric MRI of 1567 consecutive male patients from six centers (Centers 1-6) between Jan 2015 and Dec 2020. Deep learning models with double channel attention modules based on MRI (AttenNet) for predicting PCa and csPCa were constructed separately. Each model was first pretrained using 1144 PI-RADS 1-2 and 4-5 images and then retrained using 238 PI-RADS 3 images from three training centers (centers 1-3), and tested using 185 PI-RADS 3 images from the other three testing centers (centers 4-6).

Our AttenNet models achieved excellent prediction performances in testing cohort of center 4-6 with the area under the receiver operating characteristic curves (AUC) of 0.795 (95% CI: [0.700, 0.891]), 0.963 (95% CI: [0.915, 1]) and 0.922 (95% CI: [0.810, 1]) in predicting PCa, and the corresponding AUCs were 0.827 (95% CI: [0.703, 0.952]) and 0.926 (95% CI: [0.846, 1]) in predicting csPCa in testing cohort of center 4 and center 5. In particular, 71.1% to 92.2% of non-csPCa patients were identified by our model in three testing cohorts, who can spare from invasive biopsy or RP procedure.

Our model offers a noninvasive screening clinical tool to re-stratify risks in PI-RADS 3 patients, thereby reducing unnecessary invasive biopsies and improving the effectiveness of biopsies.

The deep learning model with MRI can help to screen out csPCa in PI-RADS category 3.

AttenNet models included channel attention and soft attention modules. 71.1-92.2% of non-csPCa patients were identified by the AttenNet model. The AttenNet models can be a screen clinical tool to re-stratify risks in PI-RADS 3 patients.

Treatment landscape in advanced prostate cancer (PC) is evolving. There is limited understanding of the factors influencing decision-making for genetic/genomic testing and the barriers to recommending testing and treatment in international real-world clinical practice following the approval of poly-adenosine diphosphate-ribose polymerase inhibitors (PARPi) for metastatic castration-resistant PC (mCRPC). This work aims to assess genetic/genomic testing patterns and methods, including for homologous recombination repair mutation (HRRm), and treatment decisions among physicians caring for patients with PC across the USA, Europe, and Asia.

A cross-sectional online survey of physicians treating patients with advanced PC was administered in the USA, France, Germany, Italy, Spain, UK, Japan, and China. Physicians were recruited (from August to December 2022) via clinical panels and provided informed consent. Survey questions covered factors influencing HRRm testing and treatment decision-making.

Physicians reported that 50% of patients with mCRPC are recommended for HRRm testing, and among those recommended for testing, 60% are recommended for BRCA1/2 mutation testing and 65% go on to receive HRRm testing. Overall proportions of patients recommended for testing increased following PARPi approval (from 20% to 50%) and following updated practice guidelines (from 25% to 50%). Perceived barriers to the use of genetic/genomic testing included patient refusal, lack of insurance/reimbursement, and lack of availability of adequate tissue for testing.

Overall, testing rates increased following PARPi approval and updated clinical practice guidelines; yet, there was a wide variation in the proportions of patients with mCRPC recommended for testing, and perceived barriers to testing remain, suggesting unmet needs for patients and physicians.

We surveyed physicians globally about their experience in treating patients with advanced prostate cancer and genetic testing. Physicians reported that half of patients are recommended for genetic testing, which varied across countries. We conclude that barriers to testing remain for patients and physicians.

Androgen deprivation therapy for advanced prostate cancer has traditionally relied on luteinizing hormone-releasing hormone antagonists (LHRH). However, newer oral gonadotropin hormone-releasing hormone antagonists (GnRH) offer faster responses and fewer adverse effects. A 65-year-old male diabetic patient with a history of lower urinary tract symptoms and an indwelling Foley catheter for two weeks presented with respiratory difficulty, bilateral lower limb swelling, and decreased urine output. The investigation was suggestive of locally advanced prostate cancer with obstructive uropathy along with acute or chronic kidney disease. The patient was admitted to the ICU and stabilized. An urgent bedside prostate biopsy was performed. Relugolix 360 mg orally was given on the first day followed by 120 mg daily before histopathological confirmation due to impending oliguria and progressive kidney injury. Subsequent follow-up demonstrated clinical improvements, including reduced PSA and testosterone levels, confirming the efficacy of relugolix in managing advanced prostate cancer. Timely intervention and therapeutic adherence are crucial for optimal outcomes. Additionally, it highlights the preference for LHRH agonists in emergencies and the potential of oral GnRH antagonists like relugolix in prostate cancer management.

Advances made in the screening, diagnosis and management of prostate cancer have improved the survival rates of the patients. However, many of these treatments including surgery, radiotherapy, and pharmacotherapy, have an impact on the subsequent health-related quality of life (HRQoL) of these patients. Since it is an important prognostic factor of survival, failure to evaluate the HRQoL and its predictors in these patients typically results in long-term deficits in their overall well-being, that is, their physical, social, emotional, and mental health. The objective of this study was to evaluate the management and HRQoL among patients with prostate cancer at Kenyatta National Hospital.

This was a descriptive cross-sectional study. The sample size of 62 patients who met the eligibility criteria was selected through simple random sampling on the respective clinic days of the cancer treatment centre and urology clinic. Data was collected through a pre-tested structured questionnaire and HRQoL tools which are EORTC-QLQ-C30 and EORTC-QLQ-PR25 and analysed using STATA version 13 software. Descriptive analysis was used to summarise the continuous and categorical variables. Spearman's rho (rs) correlation was used to determine the predictors of HRQoL based on the strength and significance of association at 0.05 level of significance.

The mean age of the participants was 70.5 (±7.35) years. The majority (52, 83.9%) of the patients had a prostate specific antigen (PSA) above 20 ng/ml. Twenty-one (33.9%) were graded as Gleason group 5 and 41 (66.1%) had stage IV disease at diagnosis. Fifty (80.9%) participants were on hormonal therapy, with most of them being on combined androgen blockade. The overall HRQoL was 65.1. Fatigue, one of the major complaints among these patients, was negatively associated with physical functioning (p = 0.0005), role functioning (p = 0.0026), social functioning (p = 0.0001), financial difficulties (p = 0.0077) and quality of life (p = 0.0050).

Fatigue was the most common predictor of poor HRQoL in several scales of measurement. For those on management, frequent assessment of HRQoL should be carried out and interventions instituted immediately.

Metastatic castrate-resistant prostate cancer (mCRPC) is a genetically and phenotypically heterogeneous cancer where advancements are needed in biomarker discovery and targeted therapy. A critical and often effective component of treatment includes taxanes. We perform a high-throughput screen across a cohort of 30 diverse patient-derived castrate-resistant prostate cancer (CRPC) organoids to a library of 78 drugs. Combining quantitative response measures with transcriptomic analyses demonstrates that HNF1 homeobox A (HNF1A) drives a transcriptional program of taxane resistance, commonly dependent upon cellular inhibitor of apoptosis protein 2 (cIAP2). Monotherapy with cIAP2 inhibitor LCL161 is sufficient to treat HNF1A+ models of mCRPC previously resistant to docetaxel. These data may be useful in future clinical trial designs.

Urinary dysfunction is an adverse event of low-dose-rate brachytherapy (LDR-BT) in patients with prostate cancer. We aimed to examine the time to α-1 adrenergic antagonist withdrawal after LDR-BT initiation.

We retrospectively evaluated 1663 patients who underwent LDR-BT at our hospital during 2004-2022.

Overall, 1485/1663 (89.3%) patients were able to stop using α-1 adrenergic antagonists, 1111 (66.8%) of them within 1 year of LDR-BT. Risk factors for prolonged time to withdrawal were age ≥70 years, taking agents for lower urinary tract symptoms prior to LDR-BT, an International Prostate Symptom Score ≥8, an Overactive Bladder Symptom Score ≥3 and a residual urine volume ≥20 ml. Of the patients who were able to stop taking α-1 adrenergic antagonists, 357/1485 (24.0%) required resumption, 218 (61.1%) of whom did so between 1 and 3 years after LDR-BT. This period matched the period of transient worsening of the urinary symptom score. Finally, multivariable analysis identified supplemental external beam radiotherapy and an Overactive Bladder Symptom Score ≥3 as independent risk factors for α-1 adrenergic antagonist resumption.

Withdrawal of α-1 adrenergic antagonists was possible in 66.8% of patients within 1 year of LDR-BT. Our results suggest that patients who are older or have pre-treatment LUTS may have prolonged deterioration of urinary dysfunction after treatment. Resumption of α-1 adrenergic antagonists 1-3 years after treatment may be associated with urinary symptom flares, and close attention is necessary for patients with supplemental external beam radiotherapy and a high pretreatment Overactive Bladder Symptom Score.

The aim of the present study was to assess the performance of radiolabeled-PSMA PET/CT in a cohort of intermediate-risk prostate cancer (PCa) patients for initial staging.

This is a retrospective, multicenter analysis of patients diagnosed with intermediate-risk PCa who were staged using radiolabeled PSMA PET/CT to evaluate the extent of the disease before initiating appropriate treatment. The study included patients from the Nuclear Medicine Units of the Humanitas group between 2021 and 2024. The change in management due to the PSMA PET/CT examination was assessed.

A total of 181 patients were enrolled across all three centers. Histopathological assessment from biopsy revealed that 51.4% of patients had favorable PCa, while 48.6% had unfavorable disease. PET/CT was positive for the primary lesions in all patients, but it revealed a positivity rate in 23 (12.7%) patients for nodes and distant organs, with a positivity rate of 0.21 in the unfavorable group and 0.05 in the favorable group (p < 0.005). Based on follow-up data, diagnostic accuracy was higher than 90% in both the favorable and unfavorable groups for lymph node and distant metastases. The inclusion of PSMA PET/CT in the diagnostic algorithm for patients with intermediate-risk PCa impacted patient management in 24 (13.3%) cases, based on the multidisciplinary team decision.

PSMA PET/CT can affect the management of patients with intermediate-risk PCa in up to 13% of cases, mainly for unfavorable diseases. New imaging techniques as a first-line imaging procedure can help to plan the correct therapeutic approach in the intermediate-risk PCa group.

In 2016, the Department of Veterans Affairs (VA) and the Department of Energy (DOE) established an Interagency Agreement (IAA), the Million Veteran Program-Computational Health Analytics for Medical Precision to Improve Outcomes Now (MVP-CHAMPION) research collaboration.

Oversight fell under the VA Office of Research Development (VA ORD) and DOE headquarters. An Executive Committee and 2 senior scientific liaisons work with VA and DOE leadership to optimize efforts in the service of shared scientific goals. The program supported centralized data management and genomic analysis including creation of a scalable approach to cataloging phenotypes. Cross-cutting methods including natural language processing, image processing, and reusable code were developed.

The 79.6 million dollar collaboration has supported centralized data management and genomic analysis including a scalable approach to cataloging phenotypes and launched over 10 collaborative scientific projects in health conditions highly prevalent in veterans. A ground-breaking analysis on the Summit and Andes supercomputers at the Oak Ridge National Laboratory (ORNL) of the genetic underpinnings of over 2000 health conditions across 44 million genetic variants which resulted in the identification of 38 270 independent genetic variants associating with one or more health traits. Of these, over 2000 identified associations were unique to non-European ancestry. Cross-cutting methods have advanced state-of-the-art artificial intelligence (AI) including large language natural language processing and a system biology study focused on opioid addiction awarded the 2018 Gordon Bell Prize for outstanding achievement in high-performance computing. The collaboration has completed work in prostate cancer, suicide prevention, and cardiovascular disease, and cross-cutting data science. Predictive models developed in these projects are being tested for application in clinical management.

Eight new projects were launched in 2023, taking advantage of the momentum generated by the previous collaboration. A major challenge has been limitations in the scope of appropriated funds at DOE which cannot currently be used for health research.

Extensive multidisciplinary interactions take time to establish and are essential to continued progress. New funding models for maintaining high-performance computing infrastructure at the ORNL and for supporting continued collaboration by joint VA-DOE research teams are needed.

Pelvic lymph node dissection (PLND) is important for accurate staging and prognosis of prostate and/or bladder cancer. Several guidelines recommend extended PLND for patients with these cancers. However, the therapeutic benefits of extended PLND are unclear. One major reason is that the extent of PLND is not clearly defined. Thus, the working group for standardization of robot-assisted PLND, including nine experienced urologists for PLND in Japan, was launched in January 2023 by the Japanese Society of Endourology and Robotics. This study summarized the discussions to define the individual extent of PLND in urological surgery in a consensus meeting among these experienced urologists. The consensus meeting determined the extent of PLND based on arteries (veins) and anatomical membrane structures rather than a vague concept or approach toward PLND. This concept is expected to allow surgeons to implement the same extent of PLND. Finally, after a total of 10 online web conferences were held, we determined the extent of PLND for the obturator lymph node (LN) area, the internal iliac LN area, the external and common iliac LN area, and the presacral LN area according to the above rules. The extent of PLND suggested here currently does not have a clear therapeutic rationale. Therefore, the extent of our proposed PLND is by no means mandatory. We hope our definition of the extent of PLND will be supported by further evidence of therapeutic benefits for urologic cancers.

Currently, prostate cancer (PCa) diagnosis relies on the human analysis of prostate biopsy Whole Slide Images (WSIs) using the Gleason score. Since this process is error-prone and time-consuming, recent advances in machine learning have promoted the use of automated systems to assist pathologists. Unfortunately, labeled datasets for training and validation are scarce due to the need for expert pathologists to provide ground-truth labels.

This work introduces a new prostate histopathological dataset named CrowdGleason, which consists of 19,077 patches from 1045 WSIs with various Gleason grades. The dataset was annotated using a crowdsourcing protocol involving seven pathologists-in-training to distribute the labeling effort. To provide a baseline analysis, two crowdsourcing methods based on Gaussian Processes (GPs) were evaluated for Gleason grade prediction: SVGPCR, which learns a model from the CrowdGleason dataset, and SVGPMIX, which combines data from the public dataset SICAPv2 and the CrowdGleason dataset. The performance of these methods was compared with other crowdsourcing and expert label-based methods through comprehensive experiments.

The results demonstrate that our GP-based crowdsourcing approach outperforms other methods for aggregating crowdsourced labels (κ=0.7048±0.0207) for SVGPCR vs.(κ=0.6576±0.0086) for SVGP with majority voting). SVGPCR trained with crowdsourced labels performs better than GP trained with expert labels from SICAPv2 (κ=0.6583±0.0220) and outperforms most individual pathologists-in-training (mean κ=0.5432). Additionally, SVGPMIX trained with a combination of SICAPv2 and CrowdGleason achieves the highest performance on both datasets (κ=0.7814±0.0083 and κ=0.7276±0.0260).

The experiments show that the CrowdGleason dataset can be successfully used for training and validating supervised and crowdsourcing methods. Furthermore, the crowdsourcing methods trained on this dataset obtain competitive results against those using expert labels. Interestingly, the combination of expert and non-expert labels opens the door to a future of massive labeling by incorporating both expert and non-expert pathologist annotators.

Homologous recombination repair mutation (HRRm) status may guide risk-stratification and treatment decisions, including polyadenosine diphosphate-ribose polymerase inhibitor use, in advanced prostate cancer. Although HRRm prevalence has been reported in single-institution studies or clinical trials, real-world HRRm prevalence in diverse populations is unknown. We describe HRRm in the clinical setting using two real-world clinicogenomic databases: the Flatiron Health and Foundation Medicine, Inc. Clinico-Genomic Database (CGDB), a national electronic health record-derived database, and the American Association for Cancer Research Project Genomics Evidence Neoplasia Information Exchange (GENIE).

This cross-sectional analysis included 3757 individuals diagnosed with prostate cancer who had next generation sequencing (NGS) as standard of care. The CGDB included men with advanced/metastatic prostate cancer and genetic data included both germline and somatic pathogenic mutations. The GENIE analysis included men with prostate cancer whose received NGS as standard of care, but the data were filtered to include somatic mutations only. Due to key differences among databases, direct comparisons were not possible. Overall prevalence of HRRm was calculated and stratified by demographic and clinical characteristics.

HRRm prevalence (combined germline and somatic) in CGDB (n = 487) was 24.6% (95% CI 20.9-28.7%), with no major differences across demographic and disease characteristic subgroups. HRRm prevalence (somatic) in GENIE (n = 3270) was 11.0% (95% CI 10.0-12.1%), which varied between 9.5% and 18.4% across treatment centers.

Approximately one-quarter of patients with advanced/metastatic prostate cancer in the CGDB had germline and/or somatic HRRm, which is consistent with clinical trials such as the PROfound study that used a similar NGS platform and algorithm to define HRRm. In the GENIE database, HRRm prevalence varied by treatment center or NGS platform. More research is needed to understand real-world HRRm prevalence variations.

To compare the efficacy and toxicity of docetaxel treatment regimens in metastatic castration-resistant prostate cancer (mCRPC).

We retrospectively analyzed 162 patients diagnosed with mCRPC who underwent docetaxel chemotherapy between 2009 and 2020. The patients were divided into three groups according to the dosage and interval of docetaxel (DCT) chemotherapy regimen: 30 mL/m2 weekly, 50 mL/m2 biweekly (every 2 weeks), and 75 mL/m2 triweekly (every 3 weeks).

There were no significant differences in the prostate-specific antigen (PSA) response rates (P = 0.709). The median time to progression was 3.0 [interquartile range (IQR 2.0-5.3)] months, 5.0 (IQR 2.0-13.0) months, and 5.0 (IQR 3.0-12.0) months in the weekly, biweekly, and triweekly groups, respectively (P = 0.062). The median overall survival (OS) was 12.5 (IQR 6.0-14.0) months, 18.8 (IQR 5.5-23.5) months, and 22.9 (IQR 11.0-33.0) months in the weekly, biweekly, and triweekly groups, respectively (P < 0.001). There were no differences in all toxicity and Grade 3 or higher toxicity. In Cox multivariate regression analysis, the Eastern Cooperative Oncology Group performance status (ECOG-PS), response to chemotherapy, and chemotherapy cycle also affected the PFS. Age, ECOG-PS, and chemotherapy cycle affected the OS.

The various options for optimal chemotherapy are indicated depending on the patient's conditions during the diagnosis of mCRPC. Treatment with DCT at 2-week or even 1-week intervals appears to be well tolerated in men diagnosed with mCRPC and represents a useful option when the conventional triweekly regimen is not tolerated due to poor patient condition.

As the list of histologic parameters to include in surgical pathology reports of prostate cancer biopsies grows, some pathologists include this information in the microscopic description or summary sections of the report, whereas others include it in the "topline" or final diagnosis section. This prompted us to develop a multi-institutional survey to assess reporting trends among genitourinary (GU) pathologists.

A survey instrument was shared among 110 GU pathologists via surveymonkey.com. Anonymized respondent data was analyzed.

Eighty-four (76%) participants completed the survey across four continents. Most participants report tumor volume quantitation (88%), number of cores involved (89%), and both Gleason grade and Grade group (93%) in their topline; 71% include percent of pattern 4, with another 16% including it depending on cancer grade; 58% include the presence of cribriform growth pattern 4, with another 11% including it depending on cancer grade. When present, most include extraprostatic extension (90%), prostatic intraductal carcinoma (77%), and perineural invasion (77%). Inclusion of atypical intraductal proliferation (AIP) in the topline diagnosis was cancer grade-dependent, with 74% including AIP in Grade group 1, 61% in Grade group 2, 45% in Grade group 3, 30% in Grade group 4, and 26% in Grade group 5 cancers.

Certain histologic features such as Gleason grade and tumor volume/cores involved are frequently included in the topline diagnosis, whereas the incorporation of other findings are more variably included. Prostate biopsy reporting remains a dynamic process with stylistic similarities and differences existing among GU pathologists.

Cancer genetic data from Sub-Saharan African (SSA) are limited. Patients with female breast (fBC), male breast (mBC), and prostate cancer (PC) in Rwanda underwent germline genetic testing and counseling. Demographic and disease-specific information was collected. A multi-cancer gene panel was used to identify germline Pathogenic Variants (PV) and Variants of Uncertain Significance (VUS). 400 patients (201 with BC and 199 with PC) were consented and recruited to the study. Data was available for 342 patients: 180 with BC (175 women and 5 men) and 162 men with PC. PV were observed in 18.3% fBC, 4.3% PC, and 20% mBC. BRCA2 was the most common PV. Among non-PV carriers, 65% had ≥1 VUS: 31.8% in PC and 33.6% in BC (female and male). Our findings highlight the need for germline genetic testing and counseling in cancer management in SSA.

Prostate cancer (PCa) is a high prevalence disease, per 10000 habitants, that tends to increase with age. This pathology is difficult to detect at an early stage due to the absence of symptoms, hence the importance of monitoring signs for early detection. This disease can be detected by various methods, including plasmatic levels of prostate-specific antigen (PSA) and rectal touch, with biopsy being necessary to confirm the diagnosis. Patients affected by prostate cancer can have localized or advanced disease. There are conventional approaches that have been used as a reference in localized cancer, such as active surveillance, surgery, or radiotherapy. However, the adverse effects might vary and, sometimes, they can be permanent. An overview about the innovative therapeutic approaches to improve outcomes in terms of both tumor remission and side effects for localized PCa is presented. In case of emerging light-based treatment strategies, they aimed at ablating tumor tissue by inducing an external light are non-invasive, localized and, considerably, they are able to reduce lesions in peripheral tissues. One is photodynamic therapy (PDT) and it involves the photooxidation of molecules culminating in the formation of reactive oxygen species (ROS), inducing cell death. On the other hand, photothermal therapy (PTT) is based on inducing hyperthermia in cancer cells by irradiating them with beams of light at a specific wavelength. To improve the heat generated, gold nanoparticles (AuNPs) have those desirable characteristics that have drawn attention to PTT. Various studies point to AuNPs as efficient nanomaterials in PTT for the treatment of tumors, including prostate cancer. This review includes the most representative advances in this research field, dated from 1998 to 2023. It is noticed that several advances have been made and the way to find the effective treatment without impacting adverse side effects is shorter.