Clinically locally advanced prostate cancer (PCa) is usually defined as cT3–T4 disease with or without regional nodal involvement. Multiparametric magnetic resonance imaging (mpMRI) is still the reference examination for local T staging because it combines high-resolution anatomic evaluation with functional information from diffusion-weighted imaging and, when performed, dynamic contrast-enhanced imaging. Its main strengths are the depiction of extraprostatic extension, seminal vesicle invasion, apical or bladder-neck involvement, and the delivery of side-specific information that surgeons and radiation oncologists need for planning. Its main limitation is reduced sensitivity for focal microscopic extension and for nodal metastases, for which prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is more sensitive. In current practice, mpMRI and PSMA PET/CT therefore play complementary rather than competing roles: mpMRI defines the local extent of disease, whereas PSMA PET/CT refines nodal and distant staging. Beyond initial staging, mpMRI also contributes to surgical evaluation, radiotherapy target delineation, adaptive replanning after androgen deprivation therapy, and the detection of recurrence after treatment. Interpretation after hormonal therapy, surgery, or radiotherapy, however, requires awareness of treatment-related signal changes and of the risk of both under- and overcalling recurrence. This narrative review summarizes the radiologist’s perspective on how mpMRI should be performed, interpreted, and reported in clinically locally advanced PCa. Particular emphasis is placed on staging, treatment planning, and response assessment within a multimodality imaging pathway.
This cross-sectional study examined the associations between depressive symptoms, semen parameters, employment status, and sexual outcomes in 308 men (age, mean ± standard deviation [s.d.]: 31.9 ± 6.5 years) undergoing fertility evaluation at Kirsehir Ahi Evran University Training and Research Hospital, Kirsehir, Türkiye, between January 2024 and January 2026. Participants completed the questionnaires of Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Golombok–Rust Inventory of Sexual Satisfaction (GRISS), and the International Index of Erectile Function-15 (IIEF-15). Semen analysis was performed according to the World Health Organization 2021 guidelines. Multiple linear regression revealed that depressive symptoms were the strongest independent factor associated with both erectile dysfunction (IIEF-15: β = −0.393, P < 0.001) and sexual dissatisfaction (GRISS: β = 0.421, P < 0.001), whereas semen parameters, anxiety, and age were not independently associated with sexual outcomes (all P > 0.05). Progressive motility showed a weak bivariate correlation with sexual dissatisfaction but was not an independent correlate in multivariable analysis, where depressive symptoms accounted for the observed variance. Unemployed men demonstrated lower progressive motility, normal morphology, and sperm concentration compared with employed men in bivariate analyses (all P < 0.05). These findings suggest that depressive symptoms, rather than semen quality, are the primary modifiable factor associated with sexual dissatisfaction and erectile dysfunction in men seeking fertility assessment. Routine depression screening in fertility clinics may help identify men at risk for adverse sexual outcomes.
This study compared the efficacy, safety, and intracytoplasmic sperm injection (ICSI) outcomes of artificial intelligence (AI)-assisted versus conventional microdissection testicular sperm extraction (micro-TESE) in men with non-obstructive azoospermia (NOA). To this end, we retrospectively analyzed 1286 consecutive NOA patients undergoing micro-TESE at the two reproductive medicine center of Sichuan Provincial People’s Hospital (Chengdu, China) and Sichuan Jinxin Xinan Women’s and Children’s Hospital (Chengdu, China) from January 2020 to December 2024, including 542 patients receiving AI-assisted procedures and 744 undergoing conventional surgery. The primary outcome was sperm retrieval rate (SRR), while secondary outcomes covered intraoperative parameters, postoperative complications, and ICSI outcomes, and univariable and multivariable logistic regression were performed to identify independent predictors of SRR and live birth. The results showed that the overall SRR reached 56.2% in the entire cohort, and the AI group had a significantly higher SRR (68.1% vs 47.6%, P < 0.001), with the most prominent improvement observed in patients with Sertoli cell-only syndrome (47.2% vs 22.7%, P < 0.001). The AI group also exhibited shorter operative time, less intraoperative blood loss, fewer biopsy sites, shorter postoperative hospital stay, and lower complication rates (all P < 0.001), as well as superior ICSI outcomes including higher fertilization, high-quality embryo, blastocyst, clinical pregnancy, ongoing pregnancy, and live birth rates (all P < 0.01). Further multivariable analysis confirmed that AI-assisted surgery serves as an independent predictor of both successful SRR (odds ratio [OR] = 3.182, 95% confidence interval [CI]: 2.374–4.265, P < 0.001) and live birth rate (OR = 1.876, 95% CI: 1.325–2.656, P < 0.001). Taken together, AI-assisted micro-TESE improves sperm retrieval efficiency, reduces perioperative morbidity, and enhances ICSI and live birth outcomes in NOA patients as an independent predictor for both SRR and live birth rate, and prospective multicenter randomized trials are warranted for further validation.
