To assess fracture risk in men with metastatic castration-resistant prostate cancer treated with radium-223 (Ra-223) plus enzalutamide and with prior abiraterone exposure. We evaluated patients in the Komodo Health Research Dataset who started Ra-223 plus enzalutamide between January 2016 and December 2022. In total, 171 patients were identified; 15% developed fractures. Prior abiraterone did not increase fracture risk (OR 1.00; 95% CI 0.37–2.71), and bone health agents (BHAs) lowered fracture likelihood by 79% (OR 0.21; 95% CI 0.07–0.57; p = 0.010). In Ra-223 plus enzalutamide recipients, prior abiraterone was not associated with fractures and BHAs reduced fracture incidence.
Micro-ultrasound real-time imaging technology is increasingly performed for prostate biopsy. While a learning curve is expected, the effect of operator experience on clinically significant prostate cancer (csPCa) detection has not been clearly defined. We analyzed data from the multicenter randomized OPTIMUM trial utilizing two logistic regression models to predict csPCa. Center-level experience was represented by two standardized measures derived from operator-level data: Center Case Load Score and Center Mastery Score. Model 1 included the Center Mastery Score and Center Case Volume; Model 2 excluded them. Performance was assessed using confusion matrices and the area under the curve (AUC). Experience proxies did not improve discrimination for csPCa detection. Sensitivity/specificity/AUC were 0.851/0.523/0.803 vs 0.851/0.544/0.803 for Models 1 and 2, respectively. In Model 1, experience proxies were not significant predictors; csPCa was significantly associated with increasing age (p < 0.001), higher PSA (p < 0.001), smaller prostate volume (p < 0.001), suspicious DRE (p = 0.001). Low PRI-MUS Score (1–2) was associated with decreased risk of csPCa (p = 0.001). Operator heterogeneity and potential bias in experience proxies remain limitations. Ensuring Level 3 proficiency among all participating operators and incorporating experience proxies with clinical risk factors and PRI-MUS score, center-level experience was not associated with csPCa detection. Our results reflect the successful integration of proficiency standards in clinical practice, while minimizing learning curve effects, and suggest that the required proficiency threshold was an effective proxy for mastery of microUS.
Prostate cancer epidemiology is evolving because of three simultaneous factors: a rising global burden, population aging, and renewed debate about how early detection can reduce advanced disease without returning to non-risk-adapted PSA testing. This Review provides an updated overview of prostate cancer incidence, mortality, prevalence, risk factors, disparities, and screening implications. We synthesized recent systematic reviews, meta-analyses, randomized screening trials, and population-based registry data, supplemented by landmark historical studies. Current trends cannot be interpreted without accounting for screening policy, diagnostic intensity, access to MRI and biomarkers, inherited susceptibility, and health-system capacity. Age, family history, ancestry, and germline risk remain the strongest determinants. Most modifiable exposures are weaker and inconsistent, and are better framed within cardiometabolic health and survivorship care. Organized, risk-adapted pathways integrating PSA, MRI, biomarkers, and baseline risk may better preserve early-detection benefits while reducing overdiagnosis and inequity. Progress will depend on preventing metastatic disease, minimizing overtreatment, and implementing modern diagnostics equitably.
