Abstract Objectives To evaluate the impact of 5‐alpha reductase inhibitor (5‐ARI) exposure on multiparametric MRI (mpMRI) diagnostic performance for clinically significant prostate cancer (csPCa) and to assess whether standard prostate‐specific antigen density (PSAD)‐gated biopsy thresholds remain safe in this population. Subjects/patients and methods A systematic review followed PRISMA 2020 (PROSPERO: CRD420251050507). PubMed/MEDLINE, EMBASE and the Cochrane Library were searched from January 2015 to December 2024. Eligible studies reported PI‐RADS, PSAD or lesion‐level apparent diffusion coefficient (ADC) data by exposure status, biopsy‐verified csPCa (ISUP grade group ≥2) and an unexposed comparator (≥100 patients). Risk of bias was assessed using QUADAS‐2 and ROBINS‐I; heterogeneity precluded meta‐analysis. Results Seven comparative studies met inclusion criteria. Patient‐level csPCa diagnostic accuracy was largely maintained: Sensitivity at a PI‐RADS ≥3 threshold was 93.8% in exposed versus 96.1% in unexposed men, csPCa detection was 39.1% versus 39.3% (p = 0.9), and 5‐ARI exposure was not an independent negative predictor of detection. On blinded matched review, peripheral zone lesion ADC was higher in exposed men (869 vs. 765 mm 2 /s, p = 0.04) with lower conspicuity (1.59 vs. 1.78, p = 0.03); that cohort also reported lower adjusted per‐lesion yield (OR 0.32, 95% CI 0.18–0.57), confined to the peripheral zone. A PSAD threshold of >0.15 ng/ml/cc avoided biopsy in 37.0% of exposed versus 30.3% of unexposed men, with missed csPCa in 12.3% and 11.0%, respectively. Conclusion Across seven heterogeneous observational studies, patient‐level mpMRI performance for csPCa appears largely preserved in men receiving 5‐ARIs, though this lacks pooled support and was not reproduced in the one lesion‐level, zone‐stratified analysis. Standard PSAD‐gated thresholds, evidenced by a single cohort, may perform comparably across populations. Prospective validation is required.
Abstract Objective To evaluate the safety, efficacy and feasibility of ambulatory bilateral same‐session retrograde intrarenal surgery (BSS‐RIRS) compared to unilateral RIRS, under a standardized clinical protocol. Patients and Methods We conducted a retrospective multicentre cohort study including 202 adult patients who underwent ambulatory bilateral same‐session RIRS (BSS‐RIRS) or unilateral RIRS between January 1 and December 31, 2024 . All included patients had complete perioperative data and postoperative non‐contrast CT imaging at 4–6 weeks. Of these, 95 underwent BSS‐RIRS and 107 underwent unilateral RIRS. Demographic, clinical and operative variables were analysed. Stone‐free status (defined as residual fragments ≤4 mm) and complication rates (within 30 days) were assessed. Multivariable logistic regression was used to adjust for potential confounders. Results BSS‐RIRS patients had significantly longer operative times compared to the unilateral group (106.9 vs. 87.3 minutes, p < 0.001) and were more likely to be treated with thulium lasers (73.4% vs. 54.2%, p = 0.003). Preoperative stenting was notably less common in the BSS‐RIRS group (39% vs. 65.4%, p < 0.001). Despite these differences, early complication rates remained low and statistically similar between groups (2.1% vs. 3.7%, p = 0.49), with adjusted regression analysis showing a possible non‐inferior BSS‐RIRS early complication rate (OR 0.36, p = 0.209). Overall stone‐free rates were comparable (85.3% vs. 82.3%, p = 0.56). In regression analysis, bilateral RIRS showed increased odds of stone‐free status, but this was not statistically supported (adjusted OR 1.62, 95% CI 0.64–4.10, p = 0.309). Grade A stone‐free status (0 mm residual) was significantly lower in the bilateral group (72.8% vs. 93.2%, p < 0.001). Conclusion Ambulatory BSS‐RIRS is a safe and effective approach for managing bilateral renal stones, offering comparable overall stone‐free rates and complication profiles to unilateral RIRS. Additionally, it provides procedural efficiency and potential cost‐effectiveness when applied in appropriately selected cases. Further studies are warranted to refine patient selection criteria and validate long‐term outcomes.
Abstract Objectives This study aimed to compare en bloc endovascular stapler ligation (ENBLOC) with separate clip ligation (CLIPS) for renal hilar control during robotic‐assisted nephrectomy, with emphasis on perioperative safety. Patients and methods This single‐centre retrospective cohort included 193 consecutive adults undergoing robotic‐assisted radical nephrectomy, simple nephrectomy or nephroureterectomy between January 2018 and December 2025. Patients were classified as CLIPS ( n = 66) or ENBLOC ( n = 127). Primary safety outcomes were intraoperative complications, postoperative complications and postoperative arteriovenous fistula (AVF) formation. Operative, renal functional and oncological outcomes were secondary or exploratory. Procedure‐specific subgroup analyses were also performed. Results Baseline characteristics were largely comparable, except for ASA III–IV status was more frequent in the CLIPS group (27.3% vs. 16.5%, p = 0.029). Operative time (206.5 vs. 218.0 min, p = 0.26), estimated blood loss (median 100 mL in both groups, p = 0.37) and transfusion rates (1.5% vs. 5.5%, p = 0.19) did not differ significantly. Intraoperative complications occurred in 3/66 (4.5%) CLIPS and 8/127 (6.3%) ENBLOC patients (OR 1.41, 95% CI 0.36–5.51; absolute risk difference 1.8 percentage points, 95% CI − 4.8 to 8.3; p = 0.752). Postoperative complications occurred in 5/66 (7.6%) and 9/127 (7.1%) patients, respectively ( p = 0.91). No AVF was identified during follow‐up. Exploratory subgroup analyses did not identify additional statistically significant between‐group differences, although estimates were limited by small sample sizes and sparse events. Conclusion En bloc stapler ligation was not associated with statistically significant differences in the evaluated safety outcomes compared with separate clip ligation. However, the observational design and limited number of events preclude conclusions regarding equivalence, and clinically relevant differences cannot be excluded.
Abstract Objectives This study aimed to evaluate decision regret following robot‐assisted laparoscopic partial nephrectomy (RALPN) for benign small renal masses (SRMs) in patients who did not undergo preoperative renal mass biopsy (RMB) and to assess factors associated with regret and satisfaction with treatment decision‐making. Patients and Methods We conducted a mixed methods study combining retrospective clinical data with prospective patient‐reported outcomes at a high‐volume renal cancer centre. Patients who underwent RALPN for indeterminate SRMs ≤4 cm between January 2010 and July 2025 without preoperative RMB and were subsequently found to have benign histology were identified from a prospectively maintained renal cancer database. Participants completed a standardised questionnaire incorporating the validated Decision Regret Scale (DRS). Significant regret was defined as DRS ≥ 25. Decision regret was evaluated in relation to patients' recollection of counselling and perceived quality of preoperative information. Results Of 1480 RALPN procedures performed during the study period, 167 patients met the eligibility criteria. Contact was established with 108 patients, of whom 104 agreed to participate and 58 completed the questionnaire. Median age was 66 years, and median tumour size was 30 mm. No Clavien‐Dindo Grade ≥III complications occurred. Most patients recalled being informed that the lesion could be benign (79.3%). Discussion of RMB was recalled by 55.2% of respondents, whereas 29.3% reported no recollection of biopsy discussion. Overall decision regret was low, with a mean DRS of 13.8 (95% confidence interval [CI] 10.3–17.4), although 27.6% demonstrated clinically significant regret (DRS ≥ 25). Despite benign histology, 87.9% believed surgery had been the correct decision and only 29.3% would retrospectively have preferred RMB before surgery. Lower regret scores were observed in patients who recalled detailed RMB discussion and reported higher perceived quality of preoperative counselling. Conclusion Most patients undergoing RALPN for benign small renal masses reported low decision regret despite ultimately benign pathology. Although over one‐quarter of patients demonstrated clinically significant regret, the majority remained satisfied with their treatment decision and believed surgery had been the correct choice. Comprehensive counselling regarding diagnostic uncertainty and the potential role of renal mass biopsy may help minimise subsequent regret, reinforcing the importance of shared decision‐making in contemporary small renal mass management.
Abstract Objectives This study aims to examine how patient demographics and clinical characteristics relate to mental well‐being in men with prostate cancer (PCa) on active surveillance (AS). Subjects and Methods We analysed data from the GAP3 database, established in 2014. The study included men from three cohorts who completed baseline self‐reported well‐being assessments using either the Memorial Anxiety Scale for Prostate Cancer (MAX‐PC, n = 488) or the Functional Assessment of Cancer Therapy–Prostate Emotional Well‐being Score (FACT‐P EWB, n = 497). MAX‐PC scores were categorised as mild (<9), moderate (9–27) or high anxiety (≥27), while FACT‐P EWB scores were divided into tertiles (≤18, 19–20 and ≥21; higher scores indicate better emotional well‐being). Descriptive statistics and ordinal logistic regression were used to examine associations between baseline characteristics and questionnaire scores. Results Among the men across three cohorts, 488 completed the MAX‐PC and 497 the FACT‐P EWB. In the chi2 analysis for the MAX‐PC cohort, anxiety levels were significantly associated with baseline BMI, ethnicity, marital status, education, family history of PCa, PSA levels, T stage, smoking status, Charlson Comorbidity Index and erectile dysfunction (all p < 0.001). Ordinal logistic regression showed that a family history of prostate cancer was associated with higher anxiety (OR = 1.94, 95% CI: 1.26–3.00). In contrast, no significant associations were observed in the FACT‐P EWB cohort. Conclusion Our findings highlight several baseline demographic and clinical factors associated with disease‐specific anxiety in men with PCa on AS. These results underscore the importance of routine psychosocial elements and of considering lifestyle and psychosocial factors when evaluating the supportive care needs of men considering or pursuing PCa AS.
