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.
Despite proven safety, efficacy, and durability of Holmium laser enucleation of the prostate (HoLEP), postoperative transient stress urine incontinence (SUI) was a concern for years. A technical modification of the original HoLEP, namely early apical release (EAR) has been suggested to reduce postoperative SUI. This study aimed to collate available evidence on the impact of EAR on the post HoLEP SUI and functional outcomes in comparison to conventional (non-EAR) HoLEP. Following PRISMA guidelines, a comprehensive literature search was performed until February 2026. The Search focused on studies comparing EAR with conventional HoLEP. The primary outcome was the impact of each technique on SUI. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle–Ottawa Scale and Cochrane Risk of Bias-2 tool. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated using random-effects models. Analyses were performed using RevMan 5.3. Five studies with 2821 patients were analyzed. EAR showed a lower risk of early SUI at 4–6 weeks (RR0.47, 95%CI 0.37–0.60; I² = 0.0%). At mid-term follow-up, 3–4 months, EAR was associated with lower risk of SUI (RR 0.44, 95%CI 0.28–0.69; I² = 0%). At 6–12 months, there were no significant differences in urinary incontinence. EAR had fewer intraoperative and late postoperative complications. However, EAR showed more early postoperative complications, mainly Clavien–Dindo grade I–II. Despite this, hospital stay was similar between both groups. Functional outcomes, including IPSS, quality of life, Qmax, and PVR, were comparable between groups throughout follow-up. Lastly, Operative time, enucleation time, morcellation time, and catheter duration were also comparable. EAR reduces early SUI while maintaining comparable functional outcomes compared to conventional HoLEP. These findings indicate EAR is an effective continence-optimizing modification during HoLEP.
Despite the importance of germline genetic evaluation in prostate cancer (PCa), fewer U.S. Hispanic patients receive it. We conducted semi-structured in-depth interviews with U.S. Hispanic patients with PCa in English or Spanish on facilitators and barriers to germline genetic testing. Barriers and facilitators were multidimensional. Key facilitators include family benefit, actionability, trust in clinicians, bilingual educational materials and insurance coverage; whereas key barriers include confusion with other tests, fear of negative implications, low awareness and limited clinician-led counseling. Bilingual informational materials, public messaging, and greater clinician education are needed to promote equity in PCa genetic evaluation.
Altered lipid metabolism, adiposity, and androgens have been linked to cardiac disease and prostate cancer. Adiposity increases risk of recurrence for prostate cancer and may enhance response to androgen receptor pathway inhibition (ARPI). We evaluated whether adiposity and circulating lipid metabolites are associated with response to pre-operative ADT + /- ARPI in localized high-risk prostate cancer (HRPCa). We performed a post hoc analysis of 104 men with localized HRPCa treated with 3–6 months of preoperative ADT + /- ARPI across three trials. Body composition was quantified from L3 CT imaging at baseline and at radical prostatectomy (RP; end-of-treatment [EOT] n = 56). Plasma lipid metabolites were profiled by UPLC-MS at baseline (n = 60) and in paired baseline/EOT samples (n = 59). Pathologic response was defined as ≤ T2N0 at RP. PSA progression-free survival (PFS) was defined as time from RP to PSA ≥ 0.2 ng/mL or initiation of radiotherapy. Median age was 63 years, 76.9% had Gleason grade group 4-5, and 43.7% had clinical T3-4 disease. At RP, lower visceral (VATi, p = 0.002) and subcutaneous adiposity (SATi, p = 0.004) were associated with pathologic response. Increasing adiposity at RP was associated with PSA progression (per 10-unit increase: VATi HR 1.09, p = 0.04; SATi HR 1.14, p = 0.03). In paired analyses (n = 59), pathologic responders demonstrated decreases (p < 0.05) in diacylglycerols and polyunsaturated fatty acyl chain-containing triacylglycerols (PUFA-TAGs) and elevations in ceramide species. Non-responders exhibited increases (p < 0.05) in PUFA-TAGs and glycerophospholipids with reductions in lysophosphatidylcholine species, long-chain acylcarnitine, and cholesterol. Higher post-treatment adiposity and intrapatient changes in lipid metabolite pathways were associated with inferior outcomes after pre-operative hormone therapy, supporting a stage-dependent link between cardiometabolic health and prostate cancer that warrants further elucidation.
