The perks of combining extension and Gleason score of positive surgical margins after robot-assisted radical prostatectomy.

Background: The role of positive surgical margins' (PSM) features in terms of cancer control outcomes is unclear. We aimed to test the association between PSM extension combined to highest Gleason score (GS) at margin and PSA persistence, biochemical recurrence (BCR) and clinical recurrence (CR) in prostate cancer (PCa) patients undergone robot-assisted radical prostatectomy (RARP).

Materials And Methods: 2617 PCa patients treated with RARP at six European centers were stratified according to the PSM status and features, as follows): (a) negative SM; (b) focal PSM-GS 3; (c) extensive PSM-GS 3; (d) focal PSM-GS 4-5; (d) extensive PSM-GS 4-5.

The Role of Genomic Scores in the Management of Prostate Cancer Patients: A Comprehensive Narrative Review.

Genomic score testing is increasingly being integrated into the management of prostate cancer (PCa) to overcome the limitations of traditional clinical and pathological parameters. Genomic tools will represent essential components of precision medicine, supporting risk stratification, therapeutic decision-making, and personalized screening strategies. Genomic score tests can be broadly classified into two main categories: polygenic risk scores (PRSs) and tumor-derived genomic classifiers (GCs).

Contemporary Outcomes of Robot-Assisted Partial Nephrectomy: Results from Two European Referral Institutions.

Available guidelines recommend performing nephron-sparing surgery in selected renal cell carcinoma (RCC) patients. Many studies provided robot-assisted partial nephrectomy (RAPN) functional and oncological outcomes, with most of these including a wide timespan and a number of surgeons with different experiences, which might lead to the heterogeneity of the results. In this study, we aim to provide a contemporary report of RAPN patient outcomes performed at two referral centers by experienced surgeons.

Incidence and Predictors of Acute Kidney Injury and Acute Kidney Disease After Robot-assisted Radical Prostatectomy in Prostate Cancer Patients.

Background And Objective: Acute kidney injury (AKI) and acute kidney disease (AKD) are neglected complications of robot-assisted radical prostatectomy (RARP) that may lead to chronic kidney disease (CKD). We investigated their incidence and predictors in prostate cancer (PCa) patients undergoing RARP.

Methods: Overall, 3551 consecutive patients who underwent RARP at a high-volume tertiary center were evaluated.

Tailored use of PSA density according to multiparametric MRI index lesion location: results of a large, multi-institutional series.

Background: The use of prostate-specific antigen density (PSAd) in combination with multiparametric magnetic resonance imaging (mpMRI) of the prostate can improve accuracy of the prostate cancer (PCa) diagnostic pathway. However, it is not clear whether the performance characteristics of PSAd vary according to the index lesion location (ILL) on mpMRI.

Methods: Overall, 2140 patients with positive mpMRI (prostate imaging reporting and data system [PI-RADS] ≥ 3) underwent mpMRI-targeted biopsy (TBx) plus systematic biopsy (SBx) at three tertiary referral centers.

The Role of Robot-Assisted, Imaging-Guided Surgery in Prostate Cancer Patients.

Emerging imaging-guided technologies, such as prostate-specific membrane antigen radioguided surgery (PSMA-RGS) and augmented reality (AR), could enhance the precision and efficacy of robot-assisted prostate cancer (PCa) surgical approaches, maximizing the surgeons' ability to remove all cancer sites and thus patients' outcomes. Sentinel node biopsy (SNB) represents an imaging-guided technique that could enhance nodal staging accuracy by leveraging lymphatic mapping with tracers. PSMA-RGS uses radiolabeled tracers with the aim to improve intraoperative lymph node metastases (LNMs) detection.

The added value of artificial intelligence using Quantib Prostate for the detection of prostate cancer at multiparametric magnetic resonance imaging.

Purpose: Artificial intelligence (AI) has been proposed to assist radiologists in reporting multiparametric magnetic resonance imaging (mpMRI) of the prostate. We evaluate the diagnostic performance of radiologists with different levels of experience when reporting mpMRI with the support of available AI-based software (Quantib Prostate).

Material And Methods: This is a single-center study (NCT06298305) involving 110 patients.

Preservation of Neurovascular Bundles in High-risk Prostate Cancer Patients: Long-term Oncological Outcomes from Two High-volume Tertiary Centers.

Background And Objective: Preservation of neurovascular bundles (NVBs) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) has been associated with better functional outcomes. The aim of this study is to investigate the oncological impact of NVB preservation in patients with high-risk PCa.

Methods: D'Amico high-risk PCa patients who underwent RP between 2002 and 2022 at two high-volume referral centers were included in the study analysis.

Targeting All Multiple Magnetic Resonance Imaging Prostate Lesions Does Not Enhance Cancer Detection: Insights from the YAU Prostate Cancer Group.

Background And Objective: Although diagnostic efficacy of multiparametric magnetic resonance imaging (MRI) in identifying index lesions (ILs) in prostate cancer (PCa) patients is well established, challenges arise when multiple lesions (MLs) are present. Determination of an optimal biopsy strategy for these patients is crucial. This study aims to assess the risk of detecting PCa and clinically significant PCa (csPCa; International Society of Urological Pathology [ISUP] grade group ≥2) when targeting suspicious MRI MLs in addition to the IL.

Impact of ISUP grade group on cancer-specific mortality in radical prostatectomy-treated prostate cancer patients with organ-confined disease.

Introduction: We aimed to test the impact of International Society of Urological Pathology (ISUP) grade group (GG) on cancer-specific mortality (CSM) in organ-confined (pT2) prostate cancer (PCa) at radical prostatectomy (RP).

Methods: RP organ-confined PCa patients were identified (Surveillance, Epidemiology, and End Results [SEER] 2004-2015). Cancer-specific survival (CSS) rates were tested in Kaplan-Meier plots and multivariable Cox regression (MCR) models according to GG: 1-3 vs.

External validation of nomograms including PSMA PET information for the prediction of lymph node involvement of prostate cancer.

Background: Novel nomograms predicting lymph node involvement (LNI) of prostate cancer (PCa) including PSMA PET information have been developed. However, their predictive accuracy in external populations is still unclear.

Purpose: To externally validate four LNI nomograms including PSMA PET parameters (three Muehlematter models and the Amsterdam-Brisbane-Sydney model) as well as the Briganti 2012 and MSKCC nomograms.

A Comprehensive Systematic Review and Meta-analysis of the Role of Prostate-specific Membrane Antigen Positron Emission Tomography for Prostate Cancer Diagnosis and Primary Staging before Definitive Treatment.

Background And Objective: Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) in the diagnosis and primary staging of patients with prostate cancer (PCa) has an established role, but recent summative evidence on its actual diagnostic and staging value is still missing. We aimed to collect and analyze published studies reporting the accuracy of PSMA PET for the diagnosis of clinically significant prostate cancer (csPCa) and detection of distant metastases at primary staging before definitive treatment.

Methods: We performed a systematic review of the literature, by searching the PubMed/MEDLINE, Cochrane library's CENTRAL, EMBASE, and Scopus databases, from inception to April 2024.

DNA methylation alterations in prostate cancer: from diagnosis to treatment.

Epigenetics, particularly DNA methylation, plays a crucial role in gene activation and deactivation. Indeed, modification of this pathway has been well described as promoter of cancer development in many settings. Hypermethylation of CpG islands has also been described as a significant epigenetic alteration in prostate cancer (PCa), being associated with gene silencing and tumour progression.

Time for action: actinium-225 PSMA-targeted alpha therapy for metastatic prostate cancer - a systematic review and meta-analysis.

Metastatic prostate cancer in the castration-resistant (mCRPC) setting remains challenging to treat. Prostate-specific membrane antigen (PSMA)-targeted alpha therapy (TAT) is emerging as a promising option. We aimed to systematically review the efficacy and safety of PSMA-TAT in patients with prostate cancer.

Adjuvant Radiation Therapy or Observation With or Without Early Salvage Radiation Therapy for Men With Node-Positive Prostate Cancer After Surgery and Negative Preoperative Conventional Imaging: A Multicenter Study.

Purpose: Our goals were to assess the survival outcomes of adjuvant radiation therapy (aRT) vs observation with or without early salvage radiation therapy for cN0M0 pN1 prostate cancer (PCa) and to create a model for clinical decision-making.

Materials And Methods: We retrospectively identified 1103 patients with cN0M0 PCa with pN1 PCa after surgery (2000-2021) at 18 referral centers. Kaplan-Meier curves and Cox proportional hazards models were used.

External Validation of Nomograms for the Identification of Pelvic Nodal Dissection Candidates Among Prostate Cancer Patients with Negative Preoperative Prostate-specific Membrane Antigen Positron Emission Tomography.

Background And Objective: Extended pelvic lymph node dissection (ePLND) is recommended in selected radical prostatectomy (RP) prostate cancer (PCa) patients for staging purposes. We aim to externally validate available tools to predict lymph node invasion (LNI) in men with negative preoperative prostate-specific membrane antigen positron emission tomography (miN0).

Methods: Overall, 282 intermediate- to high-risk PCa patients with miN0 disease undergoing RP and ePLND at ten centers between 2016 and 2023 were identified.

An Overview of Patient-reported Outcomes for Men with Prostate Cancer: Results from the PIONEER Consortium.

Background And Objective: Patient-reported outcome measures (PROMs) are increasingly being used to capture the patients' perspective of their functional status and quality of life (QoL). Big data can help us better understand patient-reported outcomes (PROs). Using prospectively collected data from the Prostate Cancer Diagnosis and Treatment Enhancement Through the Power of Big Data in Europe (PIONEER) consortium, we aimed to describe the functional status and QoL in men with prostate cancer (PCa) treated with active surveillance (AS), radical prostatectomy (RP), and radiotherapy (RT), and to demonstrate the applicability of PROM data on a large scale and at a European level.

Use of inpatient palliative care in metastatic testicular cancer patients undergoing critical care therapy: insights from the national inpatient sample.

To test for rates of inpatient palliative care (IPC) in metastatic testicular cancer patients receiving critical care therapy (CCT). Within the Nationwide Inpatient Sample (NIS) database (2008-2019), we tabulated IPC rates in metastatic testicular cancer patients receiving CCT, namely invasive mechanical ventilation (IMV), percutaneous endoscopic gastrostomy tube (PEG), dialysis for acute kidney failure (AKF), total parenteral nutrition (TPN) or tracheostomy. Univariable and multivariable logistic regression models addressing IPC were fitted.

Perioperative outcomes, environmental impact and economic implications of pelvic drain discontinuation in prostate cancer patients undergoing robot-assisted radical prostatectomy.

Purpose: The utility of a pelvic drain (PD) after robot-assisted radical prostatectomy (RARP) has been recently questioned. We investigated the impact of discontinuing PD placement after RARP on complications, pain, environmental benefits, and cost savings.

Methods: We identified 1,199 patients who underwent RARP with or without extended pelvic lymph node dissection from 2016 to 2023 at a referral center.

Iron deficiency anemia in pregnancy and the postpartum: a practical approach by the Italian GOAL Working Group.

Background: Iron deficiency and iron deficiency anemia represent global health issues, particularly during pregnancy and the postpartum. The present paper aims to summarize the appropriate management of these conditions in order to try to improve how clinicians perceive, diagnose and treat iron deficiency and iron deficiency anemia.

Methods: An expert panel of Italian obstetricians of Lazio region was convened to evaluate the available literature on iron deficiency and iron deficiency anemia during pregnancy and the post-partum in order to try to define a flow chart on the appropriate management of such conditions; aspects related to the patient blood management have also been investigated.