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OBJECTIVE: The aim of this study was to analyze the origins of prostatic arteries (PAs) in the Korean population and compare them with those reported in the literature. MATERIALS AND METHODS: From April 2018 to February 2024, 108 male (mean age ± standard deviation: 71.6 ± 9.7 years) with lower urinary tract symptoms (n = 102) or refractory hematuria (n = 6) underwent prostatic artery embolization (PAE). Computed tomography and angiography images were retrospectively reviewed. The branching pattern of the internal iliac artery (IIA) was classified according to the Yamaki system. The origin of the PA was categorized using the de Assis definition, and the incidence of each type was recorded. A systematic literature review was conducted and the most common types of PA were investigated. RESULTS: PAE was successfully implemented on 211 of the 216 pelvic sidewalls. PA cannulation failed in five sidewalls due to a steno-occlusive state. The most common IIA type was type A, in which the IIA was divided into the superior gluteal artery and gluteal-pudendal trunk (77%). Of 226 PAs analyzed, including 15 in 211 sidewalls exhibiting dual PAs, the most common PA origin was the internal pudendal artery (type IV, 35%), followed by the superior vesical (type I, 25%) and obturator (type III, 21%) arteries. Anterior division of IIA (type II) was less common (10%). Type V (uncommon origins) occurred in 8% of cases, including five distal internal pudendal arteries, four quadfurcations, three inferior gluteal arteries, three trifurcations, two medial femoral circumflex arteries, and two rectal arteries. Two of the five patients with surgically or endovascularly altered anatomy were successfully treated via PAs originating from the medial femoral circumflex arteries. Globally, type I is the most common PA type. CONCLUSION: In the Korean population, the most common IIA pattern and PA origin were types A and IV, respectively.

PURPOSE: To describe clinical outcomes among patients with benign prostatic hyperplasia (BPH) 24 months following prostatic artery embolization (PAE). MATERIALS AND METHODS: This was an international, multicenter, prospective trial of males with BPH with lower urinary tract symptoms (LUTS) or acute urinary retention (AUR) treated with PAE. The primary outcome was the 12 month change in the International Prostate Symptom Score (IPSS) for patients referred for bothersome LUTS, or urinary catheter independence for patients treated for AUR. Secondary outcome measures included changes in IPSS at 3 and 24 months, changes in quality of life (QoL), changes in the Sexual Health Inventory for Men (SHIM) questionnaire, technical success rate, and adverse events (AEs). Data were summarized using descriptive statistics. RESULTS: Four hundred seventy-eight consecutive patients underwent PAE (bothersome LUTS: N = 405; AUR: N = 73), mean age was 70 years. For patients treated for bothersome LUTS, mean total IPSS at baseline was 21.8 and decreased to 9.3, 10.6, and 11.2 at 3, 12, and 24 months following PAE, respectively (all p

Profound functional switch of key regulatory factors may play a major role in homeostasis and disease. Dysregulation of circadian rhythm (CR) is strongly implicated in cancer with mechanisms poorly understood. We report here that the function of REV-ERBα, a major CR regulator of the orphan nuclear receptor subfamily, is dramatically altered in tumors in both its genome binding and functional mode. Loss of CR is linked to a functional inversion of REV-ERBα from a repressor in control of CR and metabolic gene programs in normal tissues to a strong activator in different cancers. Through changing its association from NCoR/HDAC3 corepressor complex to BRD4/p300 coactivators, REV-ERBα directly activates thousands of genes including tumorigenic programs such as MAPK and PI3K-Akt signaling. Functioning as a master transcriptional activator, REV-ERBα partners with pioneer factor FOXA1 and directly stimulates a large number of signaling genes, including multiple growth factors, receptor tyrosine kinases, RASs, AKTs, and MAPKs. Moreover, elevated REV-ERBα reprograms FOXA1 to bind new targets through a BRD4-mediated increase in local chromatin accessibility. Pharmacological targeting with SR8278 diminishes the function of both REV-ERBα and FOXA1 and synergizes with BRD4 inhibitor in effective suppression of tumorigenic programs and tumor growth. Thus, our study revealed a functional inversion by a CR regulator in driving gene reprogramming as an unexpected paradigm of tumorigenesis mechanism and demonstrated a high effectiveness of therapeutic targeting such switch.

Background Intravenous prostate-specific membrane antigen (PSMA)-targeted radioligand therapy improves survival in men with metastatic castration-resistant prostate cancer. Yet, the impact of selective prostatic arterial administration on primary tumor uptake is unclear. Purpose To compare gallium 68 (68Ga)-PSMA-11 uptake using dynamic PET/CT in prostatic tumoral volumes of interest (VOIs) during intravenous and selective prostatic arterial infusions for individuals with untreated, high-risk prostate cancer. Materials and Methods In this prospective, intraindividual comparative study conducted at an academic medical center, five men aged 58, 61, 64, 66, and 68 years with treatment-naive prostate cancer were enrolled between January 2022 and February 2023 and underwent two dynamic 68Ga-PSMA-11 PET/CT examinations 1 week apart. During the first examination, the radiotracer was administered intravenously. During the second administration, the radiotracer was delivered into either the right or left prostatic artery through an angiographically placed microcatheter. The primary outcome was maximum standardized uptake value (SUVmax) in prostatic tumoral VOIs. The secondary outcomes included mean SUV (SUVmean) in prostatic tumoral VOIs and area under the SUVmean curves (AUC). Longitudinal mixed-effects models were used to compare dynamic SUVmax and SUVmean time-activity curves (TACs), and paired t tests were used for the remaining data. Results The mean SUVmax within tumoral VOIs was 14 (range, 3-43) for venous sessions and 938 (range, 460-1436) for arterial sessions (P = .008). The SUVmean within VOIs was greater during arterial sessions (P < .001) overall and 46-fold and 19-fold greater at peak uptake and final time points, respectively. The mean AUC was greater on arterial TACs than on venous TACs at 14600 SUV × min (range, 8353-20025 SUV × min) and 240 SUV × min (range, 69-622 SUV × min), respectively (P = .002). Conclusion Selective prostatic arterial infusion resulted in greater 68Ga-PSMA-11 tumoral SUV than intravenous infusion. Further study of local-regional, intra-arterial delivery of a PSMA-targeted theranostic agent is warranted in high-risk prostate cancer. ClinicalTrials.gov identifier: NCT04976257 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Civelek in this issue.

PURPOSE: Defining prostate cancer contours is a complex task, undermining the efficacy of interventions such as focal therapy. A multireader multicase study compared physicians' performance using artificial intelligence (AI) vs standard-of-care methods for tumor delineation. MATERIALS AND METHODS: Cases were interpreted by 7 urologists and 3 radiologists from 5 institutions with 2 to 23 years of experience. Each reader evaluated 50 prostatectomy cases retrospectively eligible for focal therapy. Each case included a T2-weighted MRI, contours of the prostate and region(s) of interest suspicious for cancer, and a biopsy report. First, readers defined cancer contours cognitively, manually delineating tumor boundaries to encapsulate all clinically significant disease. Then, after ≥ 4 weeks, readers contoured the same cases using AI software. Using tumor boundaries on whole-mount histopathology slides as ground truth, AI-assisted, cognitively-defined, and hemigland cancer contours were evaluated. Primary outcome measures were the accuracy and negative margin rate of cancer contours. All statistical analyses were performed using generalized estimating equations. RESULTS: The balanced accuracy (mean of voxel-wise sensitivity and specificity) of AI-assisted cancer contours (84.7%) was superior to cognitively-defined (67.2%) and hemigland contours (75.9%; P < .0001). Cognitively-defined cancer contours systematically underestimated cancer extent, with a negative margin rate of 1.6% compared to 72.8% for AI-assisted cancer contours (P < .0001). CONCLUSIONS: AI-assisted cancer contours reduce underestimation of prostate cancer extent, significantly improving contouring accuracy and negative margin rate achieved by physicians. This technology can potentially improve outcomes, as accurate contouring informs patient management strategy and underpins the oncologic efficacy of treatment.

BACKGROUND: Age is the greatest risk factor for lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH). Although LUTS/BPH can be managed with pharmacotherapy, treatment failure has been putatively attributed to numerous pathological features of BPH (eg, prostatic fibrosis, inflammation). Mitochondrial dysfunction is a hallmark of aging; however, its impact on the pathological features of BPH remains unknown. METHODS: Publicly available gene array data were analyzed. Immunohistochemistry examined mitochondrial proteins in the human prostate. The effect of complex I inhibition (rotenone) on a prostatic cell line was examined using quantitative polymerase chain reaction, immunocytochemistry, and Seahorse assays. Oleic acid (OA) was tested as a bypass of complex I inhibition. Aged mice were treated with OA to examine its effects on urinary dysfunction. Voiding was assessed longitudinally, and a critical complex I protein measured. RESULTS: Mitochondrial function and fibrosis genes were altered in BPH. Essential mitochondrial proteins (ie, voltage-dependent anion channels 1 and 2, PTEN-induced kinase 1, and NADH dehydrogenase [ubiquinone] iron-sulfur protein 3, mitochondrial [NDUFS3]) were significantly (p

Multi-parametric MRI (mpMRI) is widely used for prostate cancer (PCa) diagnosis. Deep learning models show good performance in detecting PCa on mpMRI, but domain-specific PCa-related anatomical information is sometimes overlooked and not fully explored even by state-of-the-art deep learning models, causing potential suboptimal performances in PCa detection. Symmetric-related anatomical information is commonly used when distinguishing PCa lesions from other visually similar but benign prostate tissue. In addition, different combinations of mpMRI findings are used for evaluating the aggressiveness of PCa for abnormal findings allocated in different prostate zones. In this study, we investigate these domain-specific anatomical properties in PCa diagnosis and how we can adopt them into the deep learning framework to improve the models detection performance. We propose an anatomical-aware PCa detection Network (AtPCa-Net) for PCa detection on mpMRI. Experiments show that the AtPCa-Net can better utilize the anatomical-related information, and the proposed anatomical-aware designs help improve the overall model performance on both PCa detection and patient-level classification.

Prostate cancer pathology plays a crucial role in clinical management but is time-consuming. Artificial intelligence (AI) shows promise in detecting prostate cancer and grading patterns. We tested an AI-based digital twin of a pathologist, vPatho, on 2603 histological images of prostate tissue stained with hematoxylin and eosin. We analyzed various factors influencing tumor grade discordance between the vPatho system and six human pathologists. Our results demonstrated that vPatho achieved comparable performance in prostate cancer detection and tumor volume estimation, as reported in the literature. The concordance levels between vPatho and human pathologists were examined. Notably, moderate to substantial agreement was observed in identifying complementary histological features such as ductal, cribriform, nerve, blood vessel, and lymphocyte infiltration. However, concordance in tumor grading decreased when applied to prostatectomy specimens (κ = 0.44) compared to biopsy cores (κ = 0.70). Adjusting the decision threshold for the secondary Gleason pattern from 5 to 10% improved the concordance level between pathologists and vPatho for tumor grading on prostatectomy specimens (κ from 0.44 to 0.64). Potential causes of grade discordance included the vertical extent of tumors toward the prostate boundary and the proportions of slides with prostate cancer. Gleason pattern 4 was particularly associated with this population. Notably, the grade according to vPatho was not specific to any of the six pathologists involved in routine clinical grading. In conclusion, our study highlights the potential utility of AI in developing a digital twin for a pathologist. This approach can help uncover limitations in AI adoption and the practical application of the current grading system for prostate cancer pathology.

AimsPre-surgical risk classification tools for prostate cancer have shown better patient stratification with the addition of cribriform pattern 4 (CC) and intraductal prostatic carcinoma (IDC) identified in biopsies. Here, we analyse the additional prognostic impact of CC/IDC observed in prostatectomies using Cancer of Prostate Risk Assessment post-surgical (CAPRA-S) stratification.MethodsA retrospective cohort of treatment-naïve radical prostatectomy specimens from three North American academic institutions (2010-2018) was assessed for the presence of CC/IDC. Patients were classified, after calculating the CAPRA-S scores, into low-risk (0-2), intermediate-risk (3-5) and high-risk (6-12) groups. Kaplan-Meier curves were created to estimate biochemical recurrence (BCR)-free survival. Prognostic performance was examined using Harrell's concordance index, and the effects of CC/IDC within each risk group were evaluated using the Cox proportional hazards models.ResultsOur cohort included 825 prostatectomies (grade group (GG)1, n=94; GG2, n=475; GG3, n=185; GG4, n=13; GG5, n=58). CC/IDC was present in 341 (41%) prostatectomies. With a median follow-up of 4.2 years (range 2.9-6.4), 166 (20%) patients experienced BCR. The CAPRA-S low-risk, intermediate-risk and high-risk groups comprised 357 (43%), 328 (40%) and 140 (17%) patients, and discriminated for BCR-free survival (p

PURPOSE: To assess the diagnostic performance and utility of the ExoDx IntelliScore and an OPKO4K score to predict prostate cancer in men presenting with elevated PSA-both as independent predictors and in combination with clinical/MRI characteristics. METHODS: Patients with elevated PSA were retrospectively reviewed. Abnormal tests were defined as an OPKO4K score ≥ 7.5% and an ExoDx IntelliScore ≥ 15.6. Four regression models and ROC curves were generated based on: (1) age, PSA, and DRE, (2) model 1 + OPKO4K 4Kscore ≥ 7.5%, (3) model 2 + ExoDx IntelliScore ≥ 15.6, and (4) model 3 + MRI PIRADS 4-5. RESULTS: 359 men received an OPKO4K test, 307 had MRI and 113 had ExoDx tests. 163 men proceeded to prostate biopsy and 196 (55%) were saved from biopsy. Mean age was 65.0 ± 8.7 years and mean PSA was 7.1 ± 6.1 ng/mL. Positive biopsies were found in 84 (51.5%) men. The sensitivity and negative predictive value of an OPKO4K score were 86.7% and 72.3%; values for an ExoDx test were 76.5% and 77.1%, respectively. On regression analysis, clinical markers (Age, PSA, DRE) generated an AUC of 0.559. The addition of an OPKO4K score raised the AUC to 0.653. The stepwise addition of an ExoDx score raised the AUC to 0.766. The combined use of both biomarkers, patient characteristics, and MRI yielded an AUC of 0.825. CONCLUSION: This analysis demonstrates the high negative predictive value of both the OPKO4K score and ExoDX IntelliScore independently while demonstrating that the combination of an OPKO4K score, an ExoDX IntelliScore, and MRI increases predictive capability for biopsy confirmed prostate cancer.

Accessory sex glands are recognized as targets of human disease and may have roles in reproductive success in livestock. The current experiments evaluated the influences of endogenous steroids on the development of porcine accessory sex glands, primarily in the neonatal period. When the aromatase inhibitor, letrozole, was used to inhibit the production of endogenous estrogens in the postnatal interval, growth of the seminal vesicles, prostate, and bulbourethral glands was stimulated. The weights of seminal vesicles, prostate, and bulbourethral glands approximately doubled at 6.5 weeks of age when the reduction in endogenous estrogens began at 1 week of age (p < 0.01). However, by 20 and 40 weeks of age, the weights of accessory sex glands were similar between the letrozole-treated boars and the vehicle-treated littermates indicating the growth stimulation was a transient effect when the treatment interval was short. The presence of both classical nuclear estrogen receptors and the G protein-coupled estrogen receptor in neonatal accessory sex glands indicated multiple signaling pathways might mediate the growth inhibition by endogenous estrogens. The absence of a detectable response when the classical estrogen receptors were blocked with fulvestrant (or when the androgen receptor was blocked with flutamide) suggests that endogenous estrogens act through the G protein-coupled estrogen receptor to inhibit the development of accessory sex glands during this neonatal to early juvenile interval.

BACKGROUND: After approval for clinical use in 2017 early investigations of ultra-high-field abdominal magnetic resonance imaging (MRI) have demonstrated the feasibility as well as diagnostic capabilities of liver, kidney, and prostate MRI at 7-Tesla. However, the elevation of the field strength to 7-Tesla not only brought advantages to abdominal MRI but also presented considerable challenges and drawbacks, primarily stemming from heightened artifacts and limitations in Specific Absorption Rate, etc. Furthermore, evidence in the literature is relatively scarce concerning human studies in comparison to phantom/animal studies which necessitates an investigation into the evidence so far in humans and summarizing all relevant evidence. AIM: To offer a comprehensive overview of current literature on clinical abdominal 7T MRI that emphasizes current trends, details relevant challenges, and provides a concise set of potential solutions. METHODS: This systematic review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A PubMed search, utilizing Medical Subject Headings terms such as 7-Tesla and organ-specific terms, was conducted for articles published between January 1, 1985, and July 25, 2023. Eligibility criteria included studies exploring 7T MRI for imaging human abdominal organs, encompassing various study types (in-vivo/ex-vivo, method development, reviews/meta-analyses). Exclusion criteria involved animal studies and those lacking extractable data. Study selection involved initial identification via title/abstract, followed by a full-text review by two researchers, with discrepancies resolved through discussion. Data extraction covered publication details, study design, population, sample size, 7T MRI protocol, image characteristics, endpoints, and conclusions. RESULTS: The systematic review included a total of 21 studies. The distribution of clinical 7T abdominal imaging studies revealed a predominant focus on the prostate (n = 8), followed by the kidney (n = 6) and the hepatobiliary system (n = 5). Studies on these organs, and in the pancreas, demonstrated clear advantages at 7T. However, small bowel studies showed no significant improvements compared to traditional MRI at 1.5T. The majority of studies evaluated originated from Germany (n = 10), followed by the Netherlands (n = 5), the United States (n = 5), Austria (n = 2), the United Kingdom (n = 1), and Italy (n = 1). CONCLUSION: Further increase of abdominal clinical MRI field strength to 7T demonstrated high imaging potential, yet also limitations mainly due to the inhomogeneous radiofrequency (RF) excitation field relative to lower field strengths. Hence, further optimization of dedicated RF coil elements and pulse sequences are expected to better optimize clinical imaging at high magnetic field strength.

PURPOSE: The FLAME trial provides strong evidence that MR-guided external beam radiation therapy (EBRT) focal boost for localized prostate cancer increases biochemical disease-free survival (bDFS) without increasing toxicity. Yet, there are many barriers to implementation of focal boost. Our objectives are to systemically review clinical outcomes for MR-guided EBRT focal boost and to consider approaches to increase implementation of this technique. METHODS: We conducted literature searches in four databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. We included prospective phase II/III trials of patients with localized prostate cancer underdoing definitive EBRT with MR-guided focal boost. The outcomes of interest were bDFS and acute/late gastrointestinal and genitourinary toxicity. RESULTS: Seven studies were included. All studies had a median follow-up of greater than 4 years. There were heterogeneities in fractionation, treatment planning, and delivery. Studies demonstrated effectiveness, feasibility, and tolerability of focal boost. Based on the Phoenix criteria for biochemical recurrence, the reported 5-year biochemical recurrence-free survival rates ranged 69.7-100% across included studies. All studies reported good safety profiles. The reported ranges of acute/late grade 3 + gastrointestinal toxicities were 0%/1-10%. The reported ranges of acute/late grade 3 + genitourinary toxicities were 0-13%/0-5.6%. CONCLUSIONS: There is strong evidence that it is possible to improve oncologic outcomes without substantially increasing toxicity through MR-guided focal boost, at least in the setting of a 35-fraction radiotherapy regimen. Barriers to clinical practice implementation are addressable through additional investigation and new technologies.

Distinguishing indolent from clinically significant localized prostate cancer is a major clinical challenge and influences clinical decision-making between treatment and active surveillance. The development of novel predictive biomarkers will help with risk stratification, and clinical decision-making, leading to a decrease in over or under-treatment of patients with prostate cancer. Here, we report that Trop2 is a prognostic tissue biomarker for clinically significant prostate cancer by utilizing the Canary Prostate Cancer Tissue Microarray (CPCTA) cohort composed of over 1100 patients from a multi-institutional study. We demonstrate that elevated Trop2 expression is correlated with worse clinical features including Gleason score, age, and pre-operative PSA levels. More importantly, we demonstrate that elevated Trop2 expression at radical prostatectomy predicts worse overall survival in men undergoing radical prostatectomy. Additionally, we detect shed Trop2 in urine from men with clinically significant prostate cancer. Our study identifies Trop2 as a novel tissue prognostic biomarker and a candidate non-invasive marker for prostate cancer.

Micro-ultrasound has recently been introduced as a low-cost alternative to multi-parametric MRI for imaging prostate cancer. Early clinical studies have demonstrated promising results; however, robust validation via comparison with whole-mount pathology has yet to be achieved. Due to micro-ultrasound probe design and tissue deformation during scanning, it is difficult to accurately correlate micro-ultrasound imaging planes with ground truth whole-mount pathology slides. In this study, we developed a multi-step methodology to co-register micro-ultrasound and MRI to whole-mount pathology. The three-step process had a registration error of 3.90 ± 0.11 mm and consists of: (1) micro-ultrasound image reconstruction, (2) 3D landmark registration of micro-ultrasound to MRI, and (3) 2D capsule registration of MRI to whole-mount pathology. This process was then used in a preliminary reader study to compare the diagnostic accuracy of micro-ultrasound and MRI in 15 patients who underwent radical prostatectomy for prostate cancer. Micro-ultrasound was found to have equivalent performance to retrospective MRI review for index lesion detection (91.7% vs. 80%), while demonstrating an increased detection of tumor extent (52.5% vs. 36.7%) with similar false positive regions-of-interest (38.3% vs. 40.8%). Prospective MRI review had reduced detection of index lesions (73.3%) and tumor extent (18.9%) but improved false positive regions-of-interest (22.7%) relative to micro-ultrasound and retrospective MRI. Further evaluation is needed with a larger sample size.

BackgroundHigh b-value diffusion-weighted images (DWI) are used for detection of clinically significant prostate cancer (csPCa). This study qualitatively and quantitatively compares synthesized DWI (sDWI) to acquired (aDWI) for detection of csPCa.MethodsOne hundred fifty-one consecutive patients who underwent prostate MRI and biopsy were included in the study. Axial DWI with b = 0, 500, 1000, and 2000 s/mm2 using a 3T clinical scanner using a 32-channel phased-array body coil were acquired. We retrospectively synthesized DWI for b = 2000 s/mm2 via extrapolation based on mono-exponential decay, using b = 0 and b = 500 s/mm2 (sDWI500) and b = 0, b = 500 s/mm2, and b = 1000 s/mm2 (sDWI1000). Differences in signal intensity between sDWI and aDWI were evaluated within different regions of interest (prostate alone, prostate plus 5 mm, 30 mm and 70 mm margin and full field of view). The maximum DWI value within each ROI was evaluated for prediction of csPCa. Classification accuracy was compared to Restriction Spectrum Imaging restriction score (RSIrs), a previously validated biomarker based on multi-exponential DWI. Discrimination of csPCa was evaluated via area under the receiver operating characteristic curve (AUC).ResultsWithin the prostate, mean ± standard deviation of percent mean differences between sDWI and aDWI signal were -46 ± 35% for sDWI1000 and -67 ± 24% for sDWI500. AUC for aDWI, sDWI500, sDWI1000, and RSIrs within the prostate 0.62[95% confidence interval: 0.53, 0.71], 0.63[0.54, 0.72], 0.65[0.56, 0.73] and 0.78[0.71, 0.86], respectively.ConclusionsDWI is qualitatively comparable to aDWI within the prostate. However, hyperintense artifacts are introduced with sDWI in the surrounding pelvic tissue that interfere with quantitative cancer detection and might mask metastases. In the prostate, RSIrs yields superior quantitative csPCa detection than sDWI or aDWI.

The low bioavailability of most phytochemicals limits their anticancer effects in humans. The present study was designed to test whether combining arctigenin (Arc), a lignan mainly from the seed of Arctium lappa, with green tea (GT) and quercetin (Q) enhances the chemopreventive effect on prostate cancer. We performed in vitro proliferation studies on different cell lines. We observed a strong synergistic anti-proliferative effect of GT+Q+Arc in exposing androgen-sensitive human prostate cancer LNCaP cells. The pre-malignant WPE1-NA22 cell line was more sensitive to this combination. No cytotoxicity was observed in normal prostate epithelial PrEC cells. For an in vivo study, 3-week-old, prostate-specific PTEN (phosphatase and tensin homolog) knockout mice were treated with GT+Q, Arc, GT+Q+Arc, or the control daily until 16 weeks of age. In vivo imaging using prostate-specific membrane antigen (PSMA) probes demonstrated that the prostate tumorigenesis was significantly inhibited by 40% (GT+Q), 60% (Arc at 30 mg/kg bw), and 90% (GT+Q+Arc) compared to the control. A pathological examination showed that all control mice developed invasive prostate adenocarcinoma. In contrast, the primary lesion in the GT+Q and Arc alone groups was high-grade prostatic intraepithelial neoplasia (PIN), with low-grade PIN in the GT+Q+Arc group. The combined effect of GT+Q+Arc was associated with an increased inhibition of the androgen receptor, the PI3K/Akt pathway, Ki67 expression, and angiogenesis. This study demonstrates that combining Arc with GT and Q was highly effective in prostate cancer chemoprevention. These results warrant clinical trials to confirm the efficacy of this combination in humans.

Greenblatt and his team have unveiled vertebral skeletal stem cells (vSSCs) as a critical player in the landscape of bone metastasis. This commentary delves into the transformative discoveries surrounding vSSCs, emphasizing their distinct role in bone metastasis compared to other stem cell lineages. We illuminate the unique properties and functions of vSSCs, which may account for the elevated susceptibility of vertebral bones to metastatic invasion. Furthermore, we explore the exciting therapeutic horizons opened by this newfound understanding. These include potential interventions targeting vSSCs, modulation of associated signaling pathways, and broader implications for the treatment and management of bone metastasis. By shedding light on these game-changing insights, we hope to pave the way for novel strategies that could revolutionize the prognosis and treatment landscape for cancer patients with metastatic bone disease.

Background: The purpose of this study was to evaluate the safety and outcome of rechallenge [177Lu]Lu-PSMA-I&T in newly progressed mCRPC patients after response to initial [177Lu]Lu-PSMA radioligand therapy (PRLT). Methods: We retrospectively included 18 patients who underwent rechallenge with [177Lu]Lu-PSMA-I&T. All patients presented with (i) newly progressed disease after response to initial PRLT; (ii) a [68Ga]Ga-PSMA-11 PET/CT confirming the presence of PSMA-positive metastases; iii) ECOG performance status 0–1. Adverse events were graded according to CTCAE v5.0. Response was assessed by PSA and classified according to PCWG3 recommendations. For patients who underwent restaging with [68Ga]Ga-PSMA-11 PET/CT, imaging response was categorised according to adapted PERCIST v1.0. In patients with discordant [68Ga]Ga-PSMA-11 PET/CT and PSA, other available imaging modalities were evaluated to confirm disease status. Overall survival (OS) was calculated from the first cycle of initial PRLT and rechallenge PRLT, respectively, until last patient contact or death. Results: Patients were initially treated with a median of 5 cycles (range 4–7) and were rechallenged after a median of 9 months (range 3–13). Each patient received a median of 4 (range 2–7) rechallenge cycles (median cumulative activity 26.1 GBq). None of the patients experienced life-threatening G4 adverse events during either treatment period. Grade 3 adverse events included one case of anaemia, one case of thrombocytopenia, and one case of renal failure. In 8/18 patients long-term toxicities were evaluated. Serious toxicities (≥ Grade 3) occurred in 3/8 patients (n = 1 G4 thrombocytopenia, n = 1 G4 renal failure and n = 1 pancytopenia and G4 renal failure). Best PSA50%-response was observed in 44% of patients and PSA-disease control was confirmed in 56% of patients at the last cycle. Of the 12/18 patients restaged by imaging, 6/12 (50%) patients had disease control (partial response/stable disease), 1/12 had a mixed response, and 5/12 had progression. After a median follow-up time of 25 months (range 14–44), 10 patients had died, 7 were still alive, and one patient was lost at follow-up. The median OS was 29 months (95%CI, 14.3–43.7 months) for the initial treatment and 11 months (95%CI, 8.1–13.8 months) for the first rechallenge course. Conclusion: More than half of patients benefit from rechallenge PRLT. Our analysis suggests that rechallenge may prolong survival in selected patients, with an acceptable safety profile. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the utility of the 17‐gene Genomic Prostate Score® (GPS; MDxHealth, Irvine, CA, USA) performed on prostate cancer at the positive margin of the radical prostatectomy (RP) for its association with risk of subsequent biochemical recurrence (BCR). Patients and Methods: We designed a case‐cohort for the outcome of BCR, selecting 223 from a cohort of 813 RP patients treated at Johns Hopkins from 2008 to 2017 with positive margins and available clinical data; of these, 213 had available tissue and clinical data. RNA was isolated from formalin‐fixed paraffin‐embedded tumour tissue adjacent to the positive surgical margin and the GPS was evaluable in 203 of these patients with a score ranging from 0 to 100, with higher scores indicating higher risk. All patients underwent RP with or without adjuvant radiation therapy (ART). The statistical analysis employed Cox proportional hazards regression models for outcome of BCR weighted for case‐cohort design. Results: In univariable analysis, every 20‐unit increase in the GPS was associated with a nearly threefold increase in risk of BCR (hazard ratio [HR] per 20 units 2.82, P < 0.001). In a multivariable Cox model adjusted for age, race, Cancer of the Prostate Risk Assessment Postsurgical score, Grade Group at the positive margin, and ART, the GPS was significantly associated with BCR (HR 1.56 per 20 units; 95% confidence interval 1.11–2.19; P = 0.011). The study is limited by its retrospective and single institution design. Conclusions: The GPS at the positive surgical margin could help stratify prognosis and inform clinical decision‐making regarding adjuvant therapy after RP. [ABSTRACT FROM AUTHOR]

PURPOSE: Emerging evidence suggests that the use of artificial intelligence can assist in the timely detection and optimization of therapeutic approach in patients with prostate cancer. The conventional perspective on radiomics encompassing segmentation and the extraction of radiomic features considers it as an independent and sequential process. However, it is not necessary to adhere to this viewpoint. In this study, we show that besides generating masks from which radiomic features can be extracted, prostate segmentation and reconstruction models provide valuable information in their feature space, which can improve the quality of radiomic signatures models for disease aggressiveness classification. MATERIALS AND METHODS: We perform 2,244 experiments with deep learning features extracted from 13 different models trained using different anatomic zones and characterize how modeling decisions, such as deep feature aggregation and dimensionality reduction, affect performance. RESULTS: While models using deep features from full gland and radiomic features consistently lead to improved disease aggressiveness prediction performance, others are detrimental. Our results suggest that the use of deep features can be beneficial, but an appropriate and comprehensive assessment is necessary to ensure that their inclusion does not harm predictive performance. CONCLUSION: The study findings reveal that incorporating deep features derived from autoencoder models trained to reconstruct the full prostate gland (both zonal models show worse performance than radiomics only models), combined with radiomic features, often lead to a statistically significant increase in model performance for disease aggressiveness classification. Additionally, the results also demonstrate that the choice of feature selection is key to achieving good performance, with principal component analysis (PCA) and PCA + relief being the best approaches and that there is no clear difference between the three proposed latent representation extraction techniques. [ABSTRACT FROM AUTHOR]

Prostate magnetic resonance imaging (MRI) stands as the cornerstone in diagnosing prostate cancer (PCa), offering superior detection capabilities while minimizing unnecessary biopsies. Despite its critical role, global disparities in MRI diagnostic performance persist, stemming from variations in image quality and radiologist expertise. This manuscript reviews the challenges and strategies for enhancing image quality in prostate MRI, spanning patient preparation, MRI unit optimization, and radiology team engagement. Quality assurance (QA) and quality control (QC) processes are pivotal, emphasizing standardized protocols, meticulous patient evaluation, MRI unit workflow, and radiology team performance. Additionally, artificial intelligence (AI) advancements offer promising avenues for improving image quality and reducing acquisition times. The Prostate-Imaging Quality (PI-QUAL) scoring system emerges as a valuable tool for assessing MRI image quality. A comprehensive approach addressing technical, procedural, and interpretative aspects is essential to ensure consistent and reliable prostate MRI outcomes. [ABSTRACT FROM AUTHOR]

Introduction: 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. Methods: A survey instrument was shared among 110 GU pathologists via surveymonkey.com. Anonymized respondent data was analyzed. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Low-intensity histotripsy (LIH) is a novel and safe technique for tissue ablation. This study aimed to explore the effects of LIH on canine prostate tissue and identify the degree of acute injury to the gland. We constructed and evaluated two types of acoustically responsive droplet (ARD) emulsions using either perfluoropentane (PFP) with a lipid shell or perfluoromethyl-cyclopentane (PFMCP) with lauromacrogol (L) injection. Twenty beagles were assigned to four experimental groups: ultrasound (US) + PFP (n = 6), US + PFMCP-L (n = 6), PFMCP-L (n = 5) and PFP (n = 3). The ARDs were injected transcutaneously and transabdominally into normal canine prostates under US-guided imaging. Subsequently, focused therapeutic US was employed to induce acoustic droplet vaporization and bubble cloud cavitation. The mechanical damage to canine prostate tissue was evaluated using gross and histological examination. Gross specimens showed that the injured area was dark brown. Hematoxylin and eosin-stained tissue sections of the damage zone showed significant cavity formation and interstitial edema. The total tissue damage scores in the US + PFP group were compared to those of the other three experimental groups. No statistically significant differences were observed in the extent of tissue damage and total scores among the US + PFMCP-L, PFMCP-L and PFP groups. We achieved significant mechanical tissue damage in the canine prostate using PFP ARD-based LIH that proved to be superior to that using PFMCP ARDs with LIH. [ABSTRACT FROM AUTHOR]

Accurate information on set-up error during radiotherapy is essential for determining the optimal number of treatments in hypofractionated radiotherapy for prostate cancer. This necessitates careful control by the radiotherapy staff to assess the patient's condition. This study aimed to develop an evaluation method of the temporal trends in a patient's specific prostate movement during treatment using image matching and margin values. This study included 65 patients who underwent prostate volumetric modulated arc therapy (mean treatment time, 87.2 s). Set-up errors were assessed using bone, inter-, and intra-fraction marker matching across 39 fractions. The set-up margin was determined by dividing the four periods into 39 fractions using Stroom's formula and correlation coefficient. The intra-fraction set-up error was biased in the anterior-superior (AS) direction during treatment. The temporal trend of set-up errors during radiotherapy slightly increased based on bone matching and inter-fraction marker matching, with a 1.6-mm difference in the set-up margin fractions 11 to 20. The correlation coefficient of the mean prostate movement during treatment significantly decreased in the superior-inferior direction, while remaining high in the left-right and anterior-posterior directions. Image matching contributed significantly to the improvement of set-up errors; however, careful attention is needed for prostate movement in the AS direction, particularly during short treatment times. Understanding the trend of set-up errors during the treatment period is essential in numerical information sharing on patient condition and evaluating the margins for tailored hypo-fractionated radiotherapy, considering the facility's image-guided radiation therapy technology. [ABSTRACT FROM AUTHOR]

Purpose: Bladder neck contracture after transurethral resection of the prostate is a common complication but without clear predisposing factors. In this prospective study, we evaluated the perioperative risk factors associated with bladder neck contracture after bipolar transurethral resection of the prostate. Methods: The study included 391 patients who were admitted for bipolar transurethral resection of the prostate between October 2020 to October 2023 by three experienced surgeons. Forty three patients had bladder neck contracture and their perioperative parameters were compared with randomly chosen 172 patients without bladder neck contracture. Results: There were no significant differences between the studied groups regarding the general and present history characteristics. Re-catheterization after transurethral resection of the prostate, post-operative recurrent urinary tract infection, resection speed, and associated urethral stricture were significantly higher among the bladder neck-contraction group (P < 0.05), while total PSA, total prostate weight, post void residual urine volume, resected gland weight, resection time and catheter duration were significantly lower among the bladder neck-contraction group (P < 0.05). Conclusion: Bladder neck contracture after bipolar transurethral resection of the prostate is more common among patients with small fibrotic prostate, low total PSA, small post- void residual urine volume, those with a higher incidence of post-operative recurrent urinary-tract infection and patients with a higher incidence of re-catheterization after transurethral resection of the prostate. [ABSTRACT FROM AUTHOR]

Introduction: Given the significance of the association between anthropometric variables and disease outlook, alongside prostate-specific antigen levels and prostate volume preceding prostate cancer diagnosis, coupled with limited research in this domain, our current investigation endeavors to explore the correlation between prognosis and prostate-specific antigen levels, as well as prostate volume metrics, among adult men. Material and methods: This cross-sectional study was conducted in 2020 on adult male patients over 40 years old who had been referred to Imam Khomeini Hospital in Ahvaz, Iran for annual screening. Demographic factors along with prostate-specific antigen level and prostate volume were collected by the physician and the study evaluator to examine the relationship with disease prognosis from all patients. Results: By examining 180 adult men with a mean age of 58.61 ± 10.01 years; the results show that the mean prostate volume in the total study population was 40 ± 6.93 milliliters. Analytical analysis shows that body mass index has a direct but relatively weak significant relationship with prostate volume (r=0.155, p=0.038). This is while the patients' age showed a stronger and more direct significant relationship with volume (r=0.862, p<0.001) and prostatespecific antigen (r=0.403, p<0.001). On the other hand, the relationship between prostate volume and prostate-specific antigen of patients was reported as a strong direct significant relationship (r=0.314, p<0.001). This is while the relationship between body mass index and prostate-specific antigen in the community was weak and insignificant (r=0.135, p<0.072). Conclusion: The study results indicate that the patient's age is an important factor for screening in men for prostate examination and in men over 40 years old it is considered a valuable prognostic factor. Also, body mass index level can be used as a factor to control prostate volume in adult men. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion We evaluated the incidence of and risk factors for postoperative infections after robotic‐assisted radical prostatectomy (RARP) according to the type and duration of prophylactic antibiotic administration.A total of 1038 patients underwent RARP at our institution from 2010 to 2021; 1026 patients (201 in the cefazolin [CEZ] group and 825 in the ampicillin/sulbactam [ABPC/SBT] group) were analyzed, and 12 who used other antibiotics were excluded. The primary endpoint was the incidence of urinary tract infection (UTI), surgical site infection (SSI), and remote infection (RI). T‐tests, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed. Multivariate logistic regression analysis was performed to evaluate the effect of type and duration of prophylactic antibiotic administration.The incidence of UTI was 2.5% (5/201) in the CEZ group and 3.2% (26/825) in the ABPC/SBT group, with no significant difference between groups (p = 0.622). The rates of SSI and RI were comparable between groups (p = 0.680 and 0.906, respectively). Although the duration of antimicrobial therapy was longer in the ABPC/SBT group (p < 0.001), there was no significant difference in the incidence of UTI/SSI/RI after PSM and IPTW (all p > 0.05). Multivariate logistic regression analysis showed that neither the type of antibiotic nor the duration of administration affected the incidence of UTI/SSI/RI.The risk of postoperative UTI/SSI/RI after RARP did not change with the type and duration of antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Background: Primary mesenchymal tumors of the prostate are very rare, and there is no systematic report on fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT). The aim of this research was to characterize mesenchymal tumors of the prostate on 18F-FDG PET/CT. Results: We included 13 patients with pathologically confirmed mesenchymal neoplasms of the prostate. The location, size, maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total glycolysis of the lesion (TLG), pathologic findings, and available imaging study of the tumors were reviewed. Of the 13 patients (median age, 38 years; ranged from 13 to 74 years), the mean size of the tumors was 8.8 cm in diameter ranged from 5 to 16.1 cm. SUVmax ranged from 3.1 to 17.6 (mean 9.5), MTV ranged from 4.9 to 398 cm3 (mean 109 cm3) and TLG ranged from 21.3 to 1216 g (mean 96 g). The seminal vesicles, rectum, and bladder are the most commonly affected sites of invasion, while metastasis typically occurs in the bones, lungs, and lymph nodes. Conclusions: Mesenchymal tumors of the prostate revealed large sizes and high SUVmax, MTV and TLG levels on 18F-FDG PET/CT. 18F-FDG PET/CT may be useful for accurate diagnosis, staging, and restaging, which plays an important role in the management of subsequent plans. [ABSTRACT FROM AUTHOR]

The specificity and sensitivity of a simple non-invasive multi-cancer screening method in detecting breast, lung, prostate, and colorectal cancer in breath samples were evaluated in a double-blind study. Breath samples of 1386 participants (59.7% males, median age 56.0 years) who underwent screening for cancer using gold-standard screening methods, or a biopsy for a suspected malignancy were collected. The samples were analyzed using a bio-hybrid platform comprising trained detection canines and artificial intelligence tools. According to cancer screening/biopsy results, 1048 (75.6%) were negative for cancer and 338 (24.4%) were positive. Among the 338 positive samples, 261 (77.2%) were positive for one of the four cancer types that the bio-hybrid platform was trained to detect, with an overall sensitivity and specificity of 93.9% (95% confidence interval [CI] 90.3-96.2%) and 94.3% (95% CI 92.7%-95.5%), respectively. The sensitivity of each cancer type was similar; breast: 95.0% (95% CI 87.8-98.0%), lung: 95.0% (95% CI 87.8-98.0%), colorectal: 90.0% (95% CI 74.4-96.5%), prostate: 93.0% (95% CI 84.6-97.0%). The sensitivity of 14 other malignant tumors that the bio-hybrid platform was not trained to detect, but identified, was 81.8% (95% CI 71.8%-88.8%). Early cancer (0–2) detection sensitivity was 94.8% (95% CI 91.0%-97.1%). This bio-hybrid multi-cancer screening platform demonstrated high sensitivity and specificity and enables early-stage cancer detection. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions One of the main challenges of utilizing spot‐scanning proton arc therapy (SPArc) in routine clinics is treatment delivery efficiency. Spot reduction, which relies on spot sparsity optimization (SSO), is crucial for achieving high delivery efficiency in SPArc.This study aims to develop a novel SSO approach based on the alternating directions method of multipliers (ADMM) for SPArc to achieve high treatment delivery efficiency and maintain optimal dosimetric plan quality.In this study, SSO for SPArc is based on the least‐square dose fidelity term with L0‐norm regularization. The novel optimization approach is based on the ADMM framework, in which the minimum monitor unit constraint was considered to improve the plan quality. A state‐of‐the‐art SSO method, the primal‐dual active set with continuation (PDASC) algorithm published previously, was utilized as a benchmark. Two SPArc plan groups with the same beam assignment and clinical constraint were generated, in which the former group was SPArc plan with SSO utilizing ADMM, denoted as SPArcADMM$\text{SPArc}_{\text{ADMM}}$, and the later group was SPArc with SSO utilizing PDASC, denoted as SPArcPDASC$\text{SPArc}_{\text{PDASC}}$. Nine clinical cases included five different cancer sites (brain, lung, liver, prostate, and head&neck cancer) were used. The SSO method's performance was evaluated in terms of spot sparsity level (the number of zero‐valued elements divided by the total number of elements), beam delivery time, dosimetric plan quality, and plan robustness.Compared to the SPArcPDASC$\text{SPArc}_{\text{PDASC}}$ plan, the SPArcADMM$\text{SPArc}_{\text{ADMM}}$ plan exhibits superior sparsity and higher delivery efficiency while maintaining good plan quality.This study introduces a novel spot sparsity optimization approach using the ADMM framework to improve the delivery efficiency of SPArc. Compared to the existing state‐of‐the‐art SSO method, such an approach could further enhance delivery efficiency while maintaining good plan quality, which could promote the implementation of SPArc in the clinic's. [ABSTRACT FROM AUTHOR]

Purpose: We compared surgical complications after laser prostatic photovaporization in anticoagulated versus non-anticoagulated patients. Methods: A propensity score was calculated and patients were matched, to compare postoperative complications using the Clavien-Dindo classification between the anticoagulated and non-anticoagulated groups. We also identified factors associated with complications, and perform an analysis of secondary endpoint with categories of urological complications. Results: We included all patients that benefited a photovaporization between 2013 and 2022, either 811 patients, reducing to 245 after propensity score matching for anticoagulation. After propensity score matching, there were no differences in baseline characteristics between groups. Ninety five patients (38%) were receiving anticoagulants; 162 (66%) had an ASA score ≥ 3. Among 86 patients (35%) who experienced complications within 3 months postoperatively, 92% had a Clavien Dindo score ≤ 2. By multivariate analysis, anticoagulation was not statistically significant, the only significant risk factor for complications was ASA score ≥ 3 (Odds ratio (OR) 2.2; 95% confidence interval (CI) [1.2–4.1]). Secondary endpoint analysis for hematuria found ASA score of 3 or higher and anticoagulant treatment statistically significant in univariate and multivariate analysis, with OR of 2.9 (95% CI [1.1–7.4]) and OR of 3.5 (95% CI [1.7–7.5]), respectively. Conclusion: Green light laser photovaporization of the prostate demonstrates significant safety, even in frail patients on anticoagulant therapy. [ABSTRACT FROM AUTHOR]

Purpose: Bipolar TURP is regarded as the gold standard for treatment of BPH. Historically, when compared to HOLEP, bTURP has been found to have shorter operative times and is considered more efficient. We sought to compare the efficiency, efficacy, and safety of current era HOLEP with MOSES 2.0 technology (MOLEP) and bTURP. Methods: We performed a retrospective review of patients who underwent bTURP or MOLEP at our institution between 2018 and 2023. Preoperative, intraoperative, and postoperative characteristics were collected for analysis. Analysis was done with SPSS software with significance defined as p < 0.05. Results: We identified 195 bTURPs and 918 MOLEPs performed at our institution. Men undergoing MOLEP had significantly higher pre-op prostate volume and resected weight (61 ml v 123 ml and 15 g v 70 g, p < 0.001, respectively) when compared to bTURP patients. MOLEP was completed in significantly less OR and procedure time compared to bTURP (66 min vs. 73 min, p < 0.001; 90 min vs. 111 min, p = 0.026, respectively). These results remained significant when controlling for age and prostate volume. At a mean follow up of 3.7 months, HOLEP patients were significantly more likely to be medication (0 vs. 35.84% p < 0.001) and catheter free post-operatively (0.95% vs. 5.68%, p < 0.001) compared to bTURP. Conclusion: In our contemporary cohort, MOLEP is faster and more efficient than bTURP. These findings remained significant despite being performed on larger prostates and in patients more likely to be anticoagulated. Furthermore, MOLEP patients are more likely to remain catheter and medication free at follow-up when compared to bTURP. [ABSTRACT FROM AUTHOR]

Androgens like testosterone and dihydrotestosterone are essential for the growth and development of the prostate gland. Androgenic receptors are overexpressed, which promotes the progression of prostate cancer; therefore, androgenic receptors are a key target in the therapy of prostate cancer. Enzalutamide is used to treat prostate cancer; however, it also causes toxicities such as cardiovascular toxicity, acute myocarditis, hypertension, and seizures. The objective of this research was to create novel and safer analogues of enzalutamide, followed by the prediction of the pharmacokinetic and toxicity characteristics of these enzalutamide analogues. Molecular docking studies of analogues were also done to guess how ligands will work biologically in treating prostate cancer. A total of 195 analogues were generated, and among them, 23 bioisosteres were selected for further pharmacokinetic, toxicological screening and docking studies. The predicted physical-chemical, medicinal, and ADMET characteristics of the designed bioisosteres were optimal to good compared to enzalutamide. Additionally, the drug likeness and drug score of analogues were superior to enzalutamide. According to docking studies of analogues, EZ12, EZ8, and EZ10 formed hydrogen bonds of SER778 with replaceable amide groups in enzalutamide molecules. SER778 residue may be responsible for antagonistic activity towards androgen receptors. Based on the results of the ADMET, drug likeness, drug score, and docking study of designed enzalutamide analogues, the ligands EZ12, EZ8, and EZ10 could be used to find more possible antiandrogen drugs that could be used to treat prostate cancer. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer (PCa) is the second most prevalent malignancy among males and ranks as the fifth primary cause of mortality worldwide, underscoring its substantial impact on public health. Notably, there is a lack of research focused on PCa within the context of Saudi Arabia. Consequently, this study endeavours to elucidate the knowledge, attitudes, and screening practices related to PCa among males in Jazan, Saudi Arabia. Methodology: A cross‐sectional survey was carried out on males over 40 years old in the Jazan region of Saudi Arabia between December 2022 and March 2023. The survey used a web‐based questionnaire containing questions about sociodemographic characteristics, PCa knowledge, and attitudes toward screening practices. Descriptive and inferential statistical analysis evaluated the participants' knowledge and attitudes toward PCa screening. Results: Out of the 468 male participants aged over 40 years, approximately 44% demonstrated limited awareness about PCa. Intriguingly, 60.3% of participants showed a positive attitude toward PCa screening. Moreover, 35.7% reported consulting a urologist for screening purposes. Furthermore, 25.6% had undergone a prostate‐specific antigen (PSA) test, with the predominant rationale (25.8%) being medical advice. Multivariate analysis revealed that being married (adjusted odds ratio (AOR) = 4.5, p = 0.011) and having a family history of PCa (AOR = 4.6, p = 0.001) were significant predictors of heightened PCa awareness. Concurrently, a history of PCa (AOR = 6.8, p = 0.001) and holding a postgraduate qualification (AOR = 5.5, p = 0.024) emerged as significant determinants of proactive practices toward PCa. Conclusion: The results revealed a significant lack of knowledge regarding PCa and the screening practices associated with it among the study participants. These results emphasize the urgent need to provide men with comprehensive information about the benefits and limitations of PCa screening in order to enable them to make more informed decisions. [ABSTRACT FROM AUTHOR]

High dose-rate brachytherapy presents a promising therapeutic avenue for prostate cancer management, involving the temporary implantation of catheters which deliver radioactive sources to the cancerous site. However, as catheters puncture and penetrate the prostate, tissue deformation is evident which may affect the accuracy and efficiency of the treatment. In this work, a data-driven in silico modelling procedure is proposed to simulate brachytherapy while accounting for prostate biomechanics. Comprehensive magnetic resonance and transrectal ultrasound images acquired prior, during and post brachytherapy are employed for model personalisation, while the therapeutic procedure is simulated via sequential insertion of multiple catheters in the prostate gland. The medical imaging data are also employed for model evaluation, thus, demonstrating the potential of the proposed in silico procedure to be utilised pre- and intra-operatively in the clinical setting. [ABSTRACT FROM AUTHOR]

Introduction: Benign prostatic hyperplasia (BPH) is the enlargement of the prostate gland, primarily occurring in aging men, in which transforming growth factor-beta (TGF-β) plays a critical role in prostate cell hyperproliferation and leads to uncomfortable urinary symptoms in BPH patients. Pterocarpus indicus Willd. is well known for its ethnopharmacological applications for treating ailments such as diuresis and bladder stones. Methods: This study aimed to examine the effect of P. indicus extract (PI extract) on TGF-β-induced WPMY-1 cell proliferation, followed by bioassay-guided fractionation to isolate the active metabolites. Angolensin (Ang) and maackiain (Mac) were isolated from bioassay-guided fractionation. Network analysis was performed to investigate the potential mechanisms. Furthermore, network analysis of the Ang-Mac combination in BPH highlighted the potential top ten pathways, including PI3K/AKT signaling pathway. Accordingly, subsequent investigation focused on evaluating the effect of PI extract, Ang, Mac, and Ang-Mac combination on the expression of PCNA, p53, and PI3K/AKT protein localization and expression. Results and discussion: Results revealed inhibition of cell proliferation in TGF-β-induced WPMY-1 cells, correlating with downregulated PCNA expression. While PI extract and Mac induced apoptosis via p53 upregulation, Ang and Ang-Mac combination did not significantly affect apoptosis through the p53 pathway. Additionally, both metabolites exhibited potent inhibition of p-PI3K and p-AKT protein localization and expression in the nucleus of TGF-β-induced WPMY-1 cells. This study suggests that PI extract, Ang, and Mac are promising compounds for treating BPH, as evidenced by in silico and in vitro studies. Additionally, Ang and Mac could be used to standardize PI extract in future investigations. [ABSTRACT FROM AUTHOR]

The genetic landscape of urologic cancers has evolved with the identification of actionable mutations that impact diagnosis, prognosis, and therapeutic strategies. This narrative review consolidates existing literature on genetic mutations across key urologic cancers, including bladder, renal, prostate, upper tract urothelial, testicular, and penile. The review highlights mutations in DNA damage repair genes, such as BRCA1/2 and PTEN, as well as pathway alterations like FGFR and PD-L1 overexpression. These mutations influence tumor behavior and therapeutic outcomes, emphasizing the need for precision oncology approaches. Molecular profiling, through tools like next-generation sequencing, has revolutionized patient care by enabling targeted treatment strategies, especially in cancers with distinct molecular subtypes such as luminal or basal bladder cancer and clear cell renal carcinoma. Emerging therapies, including FGFR inhibitors and immune checkpoint blockade, offer new treatment avenues, although resistance mechanisms remain a challenge. We also emphasize the importance of biomarker identification for personalized management, especially in metastatic settings where treatment intensification is often required. Future research is needed to further elucidate our understanding of the genetics affecting urologic cancers, which will help develop novel, individualized therapies to enhance oncologic outcomes. [ABSTRACT FROM AUTHOR]

Prostate Imaging Reporting and Data System version 2.1 (PI-RADS) category 3 lesions are a challenge in the clinical workflow. A better detection of the infrequently occurring clinically significant prostate cancer (csPCa) in PI-RADS 3 lesions is an important objective. The purpose of this study was to evaluate if feature maps calculated from T2-weighted (T2w) 3 Tesla (3T) MRI can help detect csPCa in PI-RADS category 3 lesions. In-house biparametric 3T prostate MRI examinations acquired between January 2019 and June 2023 because of elevated prostate-specific antigen (PSA) levels were retrospectively screened. Inclusion criteria were a PI-RADS 3 lesion and available results of an ultrasound-guided targeted and systematic biopsy. Exclusion criteria were a simultaneous PI-RADS category 4 or 5 lesion and hip replacement. Target lesions with the International Society of Urological Pathology (ISUP) grade group 1 were rated clinically insignificant PCa (ciPCa) and ≥2 csPCa. This resulted in 52 patients being included in the final analysis, of whom 11 (21.1%), 8 (15.4%), and 33 (63.5%) patients had csPCa, ciPCa, and no PCa, respectively, with the latter two groups being combined as non-csPCa. Eight of the csPCas were located in the peripheral zone (PZ) and three in the transition zone (TZ). In the non-csPCa group, 29 were located in the PZ and 12 in the TZ. Target lesions were marked with volumes of interest (VOIs) on axial T2w images. Axial T2w images were then converted to 93 feature maps. VOIs were copied into the maps, and feature quantity was retrieved directly. Features were tested for significant differences with the Mann–Whitney U-test. Univariate models for single feature performance and bivariate models implementing PSA density (PSAD) were calculated. Ten map-derived features differed significantly between the csPCa and non-csPCa groups (AUCs: 0.70–0.84). The diagnostic performance for TZ lesions (AUC: 0.83–1.00) was superior to PZ lesions (AUC: 0.74–0.85). In the bivariate models, performance in the PZ improved with AUCs >0.90 throughout. Parametric feature maps alone and as bivariate models with PSAD can (?) noninvasively identify csPCa in PI-RADS 3 lesions and could serve as a quantitative tool reducing ambiguity in PI-RADS 3 lesions. [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) is an extremely common malignant tumor of the male genitourinary system, originating from the prostate gland epithelium. Male patients are prone to relapse after treatment, which seriously threatens their health. Phosphoinositide 3‐kinase (PI3K)/protein kinase B (PKB, also known as Akt) plays an important role in the growth, invasion, and metastasis of PCa. This review aimed to present an overview of the mechanism of action of the PI3K/AKT signaling pathway in PCa and discuss the application prospects of inhibitors of this pathway in treating PCa, providing a theoretical basis and reference for its clinical treatment targets. [ABSTRACT FROM AUTHOR]

Background Ovarian cancer is among the leading causes of gynecologic cancer-related death. Past ovarian cancer screening trials using combination of cancer antigen 125 testing and transvaginal ultrasound failed to yield statistically significant mortality reduction. Estimates of ovarian cancer sojourn time—that is, the period from when the cancer is first screen detectable until clinical detection—may inform future screening programs. Methods We modeled ovarian cancer progression as a continuous time Markov chain and estimated screening modality–specific sojourn time and sensitivity using a Bayesian approach. Model inputs were derived from the screening arms (multimodal and ultrasound) of the UK Collaborative Trial of Ovarian Cancer Screening and the Prostate, Lung, Colorectal and Ovarian cancer screening trials. We assessed the quality of our estimates by using the posterior predictive P value. We derived histology-specific sojourn times by adjusting the overall sojourn time based on the corresponding histology-specific survival from the Surveillance, Epidemiology, and End Results Program. Results The overall ovarian cancer sojourn time was 2.1 years (posterior predictive P value = .469) in the Prostate, Lung, Colorectal and Ovarian studies, with 65.7% screening sensitivity. The sojourn time was 2.0 years (posterior predictive P value = .532) in the United Kingdom Collaborative Trial of Ovarian Cancer Screening's multimodal screening arm and 2.4 years (posterior predictive P value = .640) in the ultrasound screening arm, with sensitivities of 93.2% and 64.5%, respectively. Stage-specific screening sensitivities in the Prostate, Lung, Colorectal and Ovarian studies were 39.1% and 82.9% for early-stage and advanced-stage disease, respectively. The histology-specific sojourn times ranged from 0.8 to 1.8 years for type II ovarian cancer and 2.9 to 6.6 years for type I ovarian cancer. Conclusions Annual screening is not effective for all ovarian cancer subtypes. Screening sensitivity for early-stage ovarian cancers is not sufficient for substantial mortality reduction. [ABSTRACT FROM AUTHOR]

Simple Summary: Prostate cancer (PCa) is a heterogeneous disease and the second most diagnosticated cancer in men. Epidemiological information is essential to adopt the strategy of early detection. In Mexico there is paucity of epidemiological data. We observed that Mexican men present aggressive disease at diagnosis with metastatic symptoms. Seems the Mexican race is a risk factor for PCa, as African men. "OPUS program " is the actual screening protocol for Mexican men. We describe the concernment of early detection of PCa in the Mexican population to reduce the rate of metastases. Introduction: Epidemiological data are crucial for adopting primary and secondary prevention strategies and to develop screening protocols against prostate cancer (PCa). Despite the comprehensive characterization of PCa across White and Black men, there is a lack of data from the Mexican population. This manuscript presents data from the Can.Prost registry that captures PCa trends over the past two decades in Mexico City; furthermore, we aimed to compare clinical differences and oncological outcomes before and after the promotion of early detection actions through a campaign against PCa that occurred in 2014. Methods: A retrospective observational study on newly diagnosed Mexican PCa patients was carried out at the Instituto Nacional de Cancerología (INCan) in Mexico City. During 2014 and 2015, a project for the early diagnosis of PCa ("OPUS program") was launched in the aforementioned tertiary hospital. Starting at the age of 45 years, all men were invited for a PSA measurement and a specialist urologist consultation. All individuals with clinical or biochemical suspicion of PCa (PSA > 4 ng/mL), in the context of age and prostate volume, underwent ultrasound-guided transrectal prostate biopsy. Then, patients with pathologically confirmed prostate cancer were stratified according to the year of diagnosis: Group A accounted for those diagnosed between 2000 and 2014 and Group B for those patients diagnosed in the timeframe of 2015–2021. Comparisons of PCa characteristics, treatment modalities and oncologic outcomes between Group A and B were performed. Results: Overall, we collected data from 2759 PCa patients from 2000 to 2021. The median PSA at baseline was 32 ng/mL, and 25% had a family history of PCa. Overall, 25.8% were asymptomatic and 46% had a non-metastatic presentation. After the OPUS campaign, PSA at diagnosis was significantly lower across all age groups. The incidence of PCa diagnosis in asymptomatic men was higher (31.4% vs. 19.9%) and a higher proportion of men were diagnosed with organ-confined, palpable disease (46% vs. 28%) (p < 0.001). The rate of patients eligible for active/radical treatment was higher after the OPUS campaign (patients who received surgery increased from 12.78% to 32.41%; patients who underwent radiation increased from 28.38% to 49.61%). The proportion of patients diagnosed with non-clinically significant disease was negligible and remained stable across time. Conclusions: PCa in Mexican patients displays aggressive features at diagnosis, whereas the rate of non-significant disease is negligible. The introduction of early detection strategies may lead to lower symptomatic and metastatic PCa and higher opportunities for radical treatment. This emphasizes the need for public awareness and for adjustment of screening strategies to the peculiarities of the Mexican population. [ABSTRACT FROM AUTHOR]

To determine the rate of outpatient cases and identify predictors for same-day discharge (SDD) after single-port transvesical enucleation of the prostate (STEP). Retrospective analysis of all consecutive STEP cases performed at a single center by 3 surgeons from February 2019 to October 2023. The cohort was categorized into SDD cases (<8 hours until discharge) and inpatient cases. Group comparisons were made and logistic regression was used to identify predictors of SDD. A total of 152 STEP cases were performed successfully without additional ports or conversions. Fifty-two patients were pre-planned admissions, leaving 100 planned outpatient cases, of which 86% were discharged on the same day (median length of stay of 4.7 hours). Comparing the groups, inpatient cases were older, had higher Charlson Comorbidity Index (CCI) scores, higher estimated blood loss (EBL) during surgery, and more intraoperative complications than SDD patients. Univariate logistic regression identified age and CCI as the predictors associated with SDD after STEP. Notably, there were no major postoperative complications or readmissions in either group. In our 4-year experience with STEP, lower age and CCI score were significant predictors of SDD. The comprehensive evaluation criteria for discharge foster a safe recovery at home, coupled with a 0% rate of major postoperative complications and readmissions. These findings underscore the safety and efficacy of STEP, guiding patient counseling and surgeon expectations. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We aimed to compare the detection rate of prostate cancer (PCa) and clinically significant (cs) PCa by magnetic resonance imaging-guided targeted biopsy (MTBx) alone and MTBx plus systematic biopsy (SBx) using an outpatient transperineal (TP) approach under local anesthesia. METHODS: A retrospective study of patients who underwent outpatient TP prostate biopsy under local anesthesia at our tertiary institution between 2019 and 2022 was performed. To compare the proportions of PCa and csPCa in both pathways, McNemar's tests were used. Multivariable logistic regression model was fitted to determine the predictors of csPCa. RESULTS: Of 255 men included, 177 (69%) underwent MTBx alone. MTBx had similar detection rate for PCa (56%) and csPCa (47%) compared to the combination of MTBx and SBx (PCa 61%; csPCa 49%; p=0.1 and p=0.3, respectively). MTBx had lower median number of biopsy cores compared to the combination of MTBx and SBx (6 vs. 11, p<0.001). At multivariable logistic regression analysis, age (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.13, p<0.001), prior negative biopsy (OR 0.19, 95% CI 0.09-0.44, p<0.001), prostate-specific antigen density cutoff =0.15 (OR 3.17, 95% CI 1.67-6.01, p<0.001), and prostate imaging reporting and data system =4 (OR 12.2, 95% CI 4.21-35.6, p<0.001) were independent predictors of csPCa. CONCLUSIONS: MTBx showed similar diagnostic performance to the combination of MTBx and SBx in patients undergoing outpatient TP prostate biopsy. Future studies are needed to evaluate the role of MTBx in avoiding unnecessary biopsies. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer (PCa) is a highly heterogeneous disease, making tailored treatment approaches challenging. Magnetic resonance imaging (MRI), notably diffusion‐weighted imaging (DWI) and the derived Apparent Diffusion Coefficient (ADC) maps, plays a crucial role in PCa characterization. In this context, radiomics is a very promising approach able to disclose insights from MRI data. However, the sensitivity of radiomic features to MRI settings, encompassing DWI protocols and multicenter variations, requires the development of robust and generalizable models. Purpose: To develop a comprehensive radiomics framework for noninvasive PCa characterization using ADC maps, focusing on identifying reliable imaging biomarkers against intra‐ and inter‐institution variations. Materials and methods: Two patient cohorts, including an internal cohort (118 PCa patients) used for both training (75%) and hold‐out testing (25%), and an external cohort (50 PCa patients) for independent testing, were employed in the study. DWI images were acquired with three different DWI protocols on two different MRI scanners: two DWI protocols acquired on a 1.5‐T scanner for the internal cohort, and one DWI protocol acquired on a 3‐T scanner for the external cohort. One hundred and seven radiomics features (i.e., shape, first order, texture) were extracted from ADC maps of the whole prostate gland. To address variations in DWI protocols and multicenter variability, a dedicated pipeline, including two‐way ANOVA, sequential‐feature‐selection (SFS), and ComBat features harmonization was implemented. Mann–Whitney U‐tests (α = 0.05) were performed to find statistically significant features dividing patients with different tumor characteristics in terms of Gleason score (GS) and T‐stage. Support‐Vector‐Machine models were then developed to predict GS and T‐stage, and the performance was assessed through the area under the curve (AUC) of receiver‐operating‐characteristic curves. Results: Downstream of ANOVA, two subsets of 38 and 41 features stable against DWI protocol were identified for GS and T‐stage, respectively. Among these, SFS revealed the most predictive features, yielding an AUC of 0.75 (GS) and 0.70 (T‐stage) in the hold‐out test. Employing ComBat harmonization improved the external‐test performance of the GS model, raising AUC from 0.72 to 0.78. Conclusion: By incorporating stable features with a harmonization procedure and validating the model on an external dataset, model robustness, and generalizability were assessed, highlighting the potential of ADC and radiomics for PCa characterization. [ABSTRACT FROM AUTHOR]

Background: Daily adaptive radiotherapy, as performed with the Elekta Unity MR‐Linac, requires choosing between different adaptation methods, namely ATP (Adapt to Position) and ATS (Adapt to Shape), where the latter requires daily re‐contouring to obtain a dose plan tailored to the daily anatomy. These steps are inherently resource‐intensive, and quickly predicting the dose distribution and the dosimetric evaluation criteria while the patient is on the table could facilitate a fast selection of adaptation method and decrease the treatment times. Purpose: In this work, we aimed to develop a deep‐learning‐based dose‐prediction pipeline for prostate MR‐Linac treatments. Methods: Two hundred twelve MR‐images, structure sets, and dose distributions from 35 prostate patients treated with 6.1 Gy for 7 or 6 fractions at our MR‐Linac were included, split into train/test partitions of 152/60 images, respectively. A deep‐learning segmentation network was trained to segment the CTV (prostate), bladder, and rectum. A second network was trained to predict the dose distribution based on manually delineated structures. At inference, the predicted segmentations acted as input to the dose prediction network, and the predicted dose was compared to the true (optimized in the treatment planning system) dose distribution. Results: Median DSC values from the segmentation network were 0.90/0.94/0.87 for CTV/bladder/rectum. Predicted segmentations as input to the dose prediction resulted in mean differences between predicted and true doses of 0.7%/0.7%/1.7% (relative to the prescription dose) for D98%/D95%/D2% for the CTV. For the bladder, the difference was 0.7%/0.3% for Dmean/D2% and for the rectum 0.1/0.2/0.2 pp (percentage points) for V33Gy/V38Gy/V41Gy. In comparison, true segmentations as input resulted in differences of 1.1%/0.9%/1.6% for CTV, 0.5%/0.4% for bladder, and 0.7/0.4/0.3 pp for the rectum. Only D2% for CTV and Dmean/D2% for bladder were found to be statistically significantly better when using true structures instead of predicted structures as input to the dose prediction. Conclusions: Small differences in the fulfillment of clinical dose‐volume constraints are seen between utilizing deep‐learning predicted structures as input to a dose prediction network and manual structures. Overall mean differences <2% indicate that the dose‐prediction pipeline is useful as a decision support tool where differences are >2%. [ABSTRACT FROM AUTHOR]

Background: Delivery variations during radiotherapy can cause discrepancies between planned and delivered dose distribution. These variations could arise from random and systematic offsets in certain machine parameters or systematic offsets related to the calibration process of the treatment unit. Purpose: The aim of this study was to present a novel simulation‐based methodology to evaluate realistic delivery variations in three dimensions (3D). Additionally, we investigated the dosimetric impact of delivery variations for volumetric modulated arc therapy (VMAT) plans for different treatment sites and complexities. Methods: Twelve VMAT plans for different treatment sites (prostate‐, head & neck‐, lung‐, and gynecological cancer) were selected. The clinical plan used for the treatment of each patient was reoptimized to create one plan with reduced complexity (i.e., simple plan) and one of higher complexity (i.e., complex plan). This resulted in a total of 36 plans. Delivery variations were simulated by randomly introducing offsets in multi‐leaf collimator position, jaw position, gantry angle and collimator angle simultaneously. Twenty simulations were carried out for each of the 36 plans, yielding 720 simulated deliveries. To explore the impact of individual offsets, additional simulations were conducted for each type of offset separately. A 3D dose calculation was performed for each simulation using the same calculation engine as for the clinical plan. Two standard deviations (2SD) of dose were determined for every voxel for 3D‐spatial evaluations. The dose variation in certain DVH metrics, that is, D2% and D98% for the clinical target volume and five different DVH metrics for selected organs at risk, was calculated for the twenty simulated deliveries of each plan. For comparison, the effect of delivery variations was assessed by conducting measurements with the Delta4 phantom. Results: The volume of voxels with 2SD above 1% of the prescribed dose was consistently larger for the complex plans in comparison to their corresponding simple and clinical plans. 2SDs larger than 1% were in many cases, found to accumulate outside the planning target volume. For complex plans, regions with 2SDs larger than 1% were detected also inside the high dose region, exhibiting, on average, a size six times larger volume, than those observed in simple plans. Similar results were found for all treatment sites. Variation in the selected DVH metrics for the simulated deliveries was generally largest for the complex plans with few exceptions. When comparing the 2SD distribution of the measurements with the 2SD distribution from the simulations, the spatial information showed deviations outside the PTV in both simulations and measurements. However, the measured values were, on average, 35% higher for the prostate plans and 10% higher for the head & neck plans compared to the simulated values. Conclusions: The presented methodology effectively quantified and localized dose deviations due to delivery offsets. The 3D analysis provided information that was undetectable using the analysis based on DVH metrics. Dosimetric uncertainties due to delivery variations were prominent at the edge of the high‐dose region irrespective of treatment site and plan complexity. Dosimetric uncertainties inside the high‐dose region was more profound for plans of higher complexity. [ABSTRACT FROM AUTHOR]

AbstractOne of the undesirable complications of diabetes is sexual dysfunctions in males which may affect their fertility. This research aims to study the effect of C-peptide administration on the prostate of diabetic rats and focusing on exploring the role of the autophagy pathway in diabetic prostate and whether it is involved in C-peptide action. Forty adult male Wistar albino rats were separated into control group, diabetic group, diabetic + C-peptide and diabetic + C-peptide + 3-Methyladenine (autophagy inhibitor). Serum metabolic parameters and prostatic specific antigen (PSA) were measured. Markers of oxidative stress, inflammation, fibrosis, cell proliferation and cell autophagy were evaluated in prostate tissues using biochemical, western blotting and immunohistochemical techniques. C-peptide administration ameliorated the effects of diabetes on the prostate through its hypoglycaemic, antioxidant, anti-inflammatory, and antiproliferative effects which were reversed with autophagy inhibition. Thus, we concluded that C-peptide prevented the effects of diabetes on the prostate through stimulation of the autophagy pathway. [ABSTRACT FROM AUTHOR]

Nous proposons une sélection non exhaustive des principaux essais cliniques présentés courant 2023–2024 ayant retenu notre attention dans le cadre de l'oncologie-radiothérapie appliquée aux cancers urologiques et incluant la prise en charge du cancer de la prostate (radiothérapie du cancer localisé, radiothérapie après prostatectomie, réirradiation, récidive biochimique après traitement local, radiothérapie du cancer métastatique), du cancer de vessie infiltrant le muscle et du primitif rénal. Herein, we provide a non-exhaustive selection of the main clinical trials presented in 2023–2024 related to radiation-oncology used in the treatment of urological cancers including prostate cancer (radiotherapy of localized prostate cancer, post-prostatectomy irradiation, reirradiation, biochemical recurrence following local treatment, radiotherapy for metastatic cancer), muscle invasive bladder cancer and primary kidney cancer. [ABSTRACT FROM AUTHOR]