Los Angeles County+USC Medical Center, also known as County/USC, or by the abbreviation LAC+USC (and sometimes still referred to by its former name Los Angeles County General), is a 600-bed public teaching hospital located at 2051 Marengo Street in the Boyle Heights neighborhood of Los Angeles, California. As implied by the name, the hospital facility is owned by the Los Angeles County and operated by the Los Angeles County Department of Health Services, while doctors are faculty of the Keck School of Medicine of USC, who oversee more than 1,000 medical residents being trained by the faculty.The facility is one of two level I trauma centers (providing the highest level of surgical care to trauma patients) operated by Los Angeles County, the other is Harbor-UCLA Medical Center..
Purpose/Objective(s) The management of pathologic node-positive (pN1) prostate cancer following radical prostatectomy (RP) is controversial. Randomized postoperative radiotherapy trials largely exclude pN1 patients, and it remains unclear whether low-volume pN1 disease behaves more like high-risk node-negative disease or represents early systemic spread. We report oncologic and toxicity outcomes in a uniformly treated pN1 cohort managed with pelvic radiotherapy (RT) and androgen deprivation therapy (ADT) in the PSMA PET era. Materials/Methods We retrospectively reviewed 103 pN1 patients treated with adjuvant or early salvage RT between 2019–2026. Median age at RP was 67 years. Adverse features were common: Grade Group 4–5 (66%), pT3 disease (96%), extracapsular extension (93%), seminal vesicle invasion (70%), and positive margins (55%). Median lymph nodes removed was 20, with a median of 1 positive node (range 1–8). Persistent postoperative PSA was present in 65% (median 0.14 ng/mL). PSMA PET was obtained pre-RT in 30%. Pelvic nodal RT was delivered in 99% using a sequential boost approach (45 Gy pelvis followed by prostate fossa boost to 64–68 Gy) or a simultaneous integrated boost (SIB) technique to 62.5 Gy. 92% received ADT (8% ≤ 6 months) and 5% also received an ARPI. Results At a median follow-up of 4.7 years post RP and following completion of radiation, 34% developed a detectable PSA and 21% developed metastatic disease. Among those with metastases, 17% were oligometastatic and 4% had diffuse disease. Sites of distant failure included nodal (10%) and osseous (16%) metastases. Visceral metastasis developed in one patient with neuroendocrine differentiation. Isolated prostate fossa recurrence was rare (1%). Pelvic nodal recurrence occurred in 4%, including the one patient treated with prostate fossa–only RT, supporting high regional control. Castration resistant disease developed in 8%. Two patients (2%) died; 4-year overall survival was 97.8% and metastasis-free survival of 87%.Acute GU toxicity was grade 1–2 in 86% and acute GI toxicity was grade 1–2 in 35%. There was no acute grade ≥3 toxicity. Late GU toxicity was grade 1–2 in 50% and grade ≥3 in 17%. Late GI toxicity was grade 1–2 in 6% and grade ≥3 in 2%. Conclusion In this PSMA PET–era cohort of predominantly low-volume pN1 patients treated with pelvic RT (sequential or SIB) and long-course ADT, durable local-regional control was achieved with 87% metastasis-free survival at 4 years. However, approximately one in eight patients developed metastatic progression by 4 years despite aggressive multimodality therapy, supporting the concept that while many low-volume pN1 patients behave similarly to high-risk node-negative disease, a clinically meaningful subset demonstrates early systemic biology. These findings provide modern benchmark outcomes and inform ongoing efforts toward improved risk stratification and systemic intensification in pN1 prostate cancer.
Healthcare facilities and systems are at extremely high risk of cyberattacks, with ransomware posing a significant threat to hospital operations and patient safety. Trauma centers are at particular risk for the many potential adverse impacts of a ransomware attack given the time and resource dependency of emergency trauma and surgical care. This review highlights current knowledge on ransomware, its mechanisms, types of attacks, prevention strategies, immediate and delayed response protocols, and the emerging role of artificial intelligence in both cybersecurity attacks and defensive efforts. Emphasis is placed on the unique vulnerabilities of healthcare systems, including legacy IT infrastructure and human factors, and on best practices to mitigate risks. Effective prevention strategies include regular employee training programs to heighten awareness, implementation of robust backup and recovery systems to minimize downtime, and continuous updating of IT infrastructure to close security gaps. The review highlights lessons learned from recent ransomware attacks against trauma centers, including the critical importance of institutional leadership, employee training, and robust backup systems to ensure resilience against ransomware incidents.
