Introduction: Clinical staging based on digital rectal examination is imprecise, leading to pathological upstaging in patients with prostate cancer (PCa). Accurate preoperative assessment remains a challenge despite the use of multiparametric magnetic resonance imaging (mpMRI) and fusion-guided biopsy. This study aims to identify key predictors of upstaging in preoperative patients. Materials and Methods: A retrospective analysis of 924 patients who underwent radical prostatectomy between July 2012 and January 2025 was performed. Variables included prostate-specific antigen, prostate volume, biopsy type, MRI, body mass index and age. Upstaging was defined as ≥pT3 in patients staged clinically as cT1-2. Optimal cut-offs for continuous variables were defined statistically. Multivariable logistic regression was applied to identify independent predictors of upstaging and minor staging upgrading (MSU)-defined as any upward shift in the pathological T stage relative to the clinical T stage. Model performance was evaluated using the area under the Receiver Operating Characteristic (ROC) curve (AUC). Results: Upstaging occurred in 31.9% and MSU in 50.6% of patients. The mean age was 65 years. Cut-off values for PSA density (PSAD) were 0.29 for upstaging and 0.28 for MSU. In the full-cohort model (AUC = 0.628), PSAD (odds ratio (OR) = 2.55), age (OR = 1.04), and hypertension (HT) (OR = 1.47) were associated with upstaging. In PIRADS-based models, PIRADS 5 and PSAD predicted both upstaging (OR = 1.62 and 6.10, respectively; AUC = 0.664) and MSU (OR = 1.75 and 4.67, respectively; AUC = 0.659). MSU was also associated with HT and a lack of fusion biopsy (AUC = 0.622). Conclusions: PSAD and PIRADS 5 lesions are strong determinants of pathological upstaging and MSU in PCa. These factors should be considered in preoperative risk stratification to improve staging accuracy. Despite advances in imaging and biopsy techniques, upstaging remains a common phenomenon, underlining the need for further refinement of diagnostic protocols.

Introduction Perineural invasion (PNI) is an independent prognostic factor in prostate cancer (PCa) patients following radical prostatectomy (RP), although findings across studies remain inconsistent. We aimed to identify the baseline factors associated with the occurrence of PNI in RP specimens. Methods A retrospective analysis was conducted on 921 PCa patients who underwent RP at our institution between 2012 and 2022. Baseline predictors and histopathological PNI status were analyzed. Patients were categorized into PNI+ (n = 838) and PNI- (n = 83) groups. Results Among demographic variables, family history of both PCa (p = 0.001) and other cancers (p = 0.001) was correlated with PNI. Several clinicopathological variables, including average prostate-specific antigen (PSA) at diagnosis-mean biopsy PSA (p < 0.001), mean preoperative PSA (p < 0.001), prostate volume (PV) (p = 0.034), and biopsy Grade Group (GG) (p = 0.043), showed correlation with PNI. Conversely, none of the other serum parameters, including preoperative testosterone, albumin, platelets, neutrophils, lymphocytes, and hemoglobin, exhibited correlation with PNI. Logistic regression analysis showed that a family PCa history decreases the risk of PNI (odds ratio [OR] = 0.373). Conclusions We found a correlation of PNI with recognized prognostic factors (biopsy PSA, preoperative PSA, and biopsy GG) but also with other variables (PV, family history of PCa, and family history of other cancers).

BACKGROUND:In addition to well-established immune checkpoints (ICs), such as CTLA-4, PD-1, PD-L1, increasing attention is being directed toward next-generation ICs, including TIM-3, Gal-9, LAG-3, BTLA, HVEM, and CD160. Single nucleotide polymorphisms (SNPs) within IC-related genes may contribute to dysregulation of inhibitory pathways and impair anti-tumor immune responses. This study aimed to evaluate the association between selected IC gene variants and susceptibility to bladder cancer (BC). PATIENTS AND METHODS:A total of twelve SNPs located in TIM-3, LGALS9, BTLA, HVEM, and CD160 genes were genotyped using TaqMan assays in 314 BC patients and over 520 healthy controls (HC). Genotype distributions were analyzed under multiple genetic models, and associations with clinicopathological parameters were assessed using multivariate logistic regression. RESULTS:Genotype distributions of BTLA polymorphisms (rs2705511, rs1982809, rs9288953) differed between BC patients and HC, suggesting potential associations with BC risk. Stratified analyses revealed sex-specific effects, with variants in BTLA (rs1982809), HVEM (rs1886730, rs2234167, rs8725), and CD160 (rs231375) showing potential associations with susceptibility among women. Additionally, SNPs in BTLA and HVEM were nominally associated with recurrence and high-grade tumors, while CD160 and LGALS9 variants were potentially linked to primary tumor occurrence. However, these associations lost statistical significance after correction for multiple comparisons. CONCLUSIONS:Although the observed associations did not remain significant after multiple testing correction, the results suggest that genetic variation within BTLA, HVEM, and CD160 genes may still play a biologically relevant role in BC susceptibility and disease progression. These findings underscore the potential importance of IC pathways in BC pathogenesis and warrant further investigation in larger, well-powered studies.

Robot-assisted radical prostatectomy (RARP) requires a balance between complete cancer excision and preservation of urinary continence and erectile function. Because the preservation of neurovascular bundles adjacent to the prostate surface contributes to postoperative functional recovery, intraoperative margin assessment and surgeon-guidance technologies may help refine resection and support individualized nerve-sparing decision-making. Neurovascular structure-adjacent frozen-section examination remains the most studied and clinically established method, with evidence supporting reduced positive surgical margins and broader nerve preservation, but its use is limited by cost, workflow complexity, and pathology infrastructure. Fluorescence confocal microscopy is promising but remains limited by short and apical margins; its improved accuracy for longer margins raises concerns about its reliability for routine intraoperative margin assessment. Other optical, spectroscopic, and prostate-specific membrane antigen-targeted molecular margin assessment techniques have demonstrated inconsistent diagnostic performance, with particularly low sensitivity for assessment approaches remain investigational, whereas intraoperative ultrasound, three-dimensional and augmented-reality models, fluorescence guidance, and image-enhancement systems should be viewed as surgical guidance tools rather than direct margin-assessment methods. Intraoperative technologies may improve surgical decision-making during RARP, but prospective multicenter studies with standardized oncological and functional endpoints are needed before broader adoption.

Background/Objectives: Prostate cancer remains one of the most common malignancies in men, and prognosis remains particularly challenging in patients with lymph node metastases. Cyclooxygenase-2 (COX-2), an inducible enzyme involved in inflammation and tumor progression, has been investigated as a potential prognostic biomarker and therapeutic target, but its expression in lymph node metastases remains unclear. While COX-2 overexpression in primary prostate tumors has been reported, its expression in lymph node metastases has not been thoroughly investigated. Therefore, this study aimed to compare COX-2 expression in primary prostate tumors and corresponding lymph node metastases and to evaluate its association with clinicopathological characteristics and survival. Methods: This study included 77 treatment-naïve patients with prostate cancer and histologically confirmed lymph node metastases who underwent radical prostatectomy with extended lymphadenectomy. COX-2 expression was assessed using immunohistochemistry in paired samples from primary tumors and corresponding lymph node metastases. Statistical comparisons were conducted using the Mann–Whitney U test and survival analyses were performed using Kaplan–Meier curves with the log-rank test. Results: COX-2 expression was detected in both primary tumors and lymph node metastases, with no significant difference in staining intensity between the two sites. High COX-2 expression in primary tumors was significantly associated with a higher percentage of involved lymph nodes (30.0% vs. 11.8%, p = 0.026), elevated postoperative PSA levels (1.98 vs. 0.10 ng/mL, p = 0.007), and reduced surgical radicality (11.1% vs. 63.2%, p = 0.008). Moreover, elevated COX-2 expression in both primary and metastatic tissues correlated with worse five-year overall survival (41.7% vs. 92.8%, p = 0.033; and 40.0% vs. 95.6%, p < 0.001, respectively). Conclusions: High COX-2 expression is associated with adverse clinicopathological features and poorer survival in lymph node–positive prostate cancer. The association of COX-2 expression with the extent of lymph node involvement and survival suggests that COX-2 may have prognostic value in this setting. However, the present findings do not establish a causal role of COX-2 in disease progression or lymphangiogenesis. Further studies are warranted to validate the prognostic significance of COX-2 and to clarify its potential biological and therapeutic relevance in lymph node–positive prostate cancer.

Background and objective:Perineural invasion (PNI) in prostate cancer (PC) has been linked to adverse oncological outcomes. The objective of this study was to evaluate the association between PNI identified in radical prostatectomy (RP) specimens and survival outcomes. Methods:A systematic literature search was conducted in December 2024 using PubMed (MEDLINE), Embase, Scopus, and Web of Science Core Collection databases. We included studies reporting on PNI in RP specimens and its association with primary endpoints (biochemical recurrence [BCR] or BCR-free survival) and/or secondary endpoints (cancer-specific survival [CSS], overall survival, recurrence-free survival, disease-free survival [DFS], or metastasis-free survival). Key findings and limitations:A total of 58 studies met the inclusion criteria. A meta-analysis of 40 studies (27 030 patients) demonstrated that PNI was associated with BCR (pooled hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.28-1.52; p < 0.001). Further analyses showed that PNI was linked to worse CSS (n = 903; pooled HR 2.9, 95% CI 1.1-8.1; p = 0.048). The association with DFS was not statistically significant (n = 1008; pooled HR 1.8, 95% CI 0.7-4.3; p = 0.1). The main limitation is the reliance on predominantly retrospective studies with small samples and high risk of bias. Conclusions:Our findings indicate that PNI identified in RP specimens is associated with higher risk of BCR, as well as worse CSS, which underscores its relevance as a prognostic factor in PC. Patient summary:We found that detection of cancer cells around nerves, which is called perineural invasion (PNI), in specimens after surgery to remove the prostate, is linked to a higher chance of worse survival outcomes in prostate cancer. Men with PNI were more likely to experience biochemical recurrence and had worse cancer-specific survival. PNI may help in identifying patients at higher risk after surgery who could benefit from closer follow-up or additional treatment. However, more high-quality studies are needed to confirm its role in guiding long-term care.

The aim of this study was to evaluate differences in safety and efficacy outcomes of PCNL between elderly and non-elderly patients, with special focus on commonly applied age cut-off values. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Comparative studies evaluating outcomes of PCNL in elderly versus non-elderly patients were identified through comprehensive searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library up to February 2026. Primary outcomes included overall, minor, and major complications, as well as stone-free rate (SFR). Subgroup analyses were performed according to different age thresholds used to define elderly populations (60, 65, and 70 years). Seventeen studies encompassing 45,603 patients, including 10,745 elderly individuals, were included. When pooled across all age definitions, rates of overall complications (OR 1.20, 95

Bladder cancer (BC) is a common malignancy with high recurrence and substantial monitoring costs. Limitations of current diagnostic tools: cystoscopy is invasive and expensive, urine cytology lacks sensitivity and existing urine biomarkers cannot replace cystoscopy, underscoring the need for improved non-invasive methods. Immune checkpoints (ICs) regulate immune activity, and newer ICs: T-cell immunoglobulin and mucin domain 3 (TIM-3), galectin-9 (Gal-9), B- and T-lymphocyte attenuator (BTLA), herpesvirus entry mediator (HVEM), cluster of differentiation 160 (CD160), and lymphocyte-activation gene 3 (LAG-3), are involved in cancer immune evasion. This study demonstrated that levels of soluble ICs (sICs) are markedly elevated in patients with early-stage BC. Serum levels of sTIM-3, sGal-9, sBTLA, sHVEM, sCD160, and sLAG-3 were quantified in BC and controls. sTIM-3, sGal-9, and sBTLA were significantly elevated in BC, while their concentrations didn’t vary by tumor stage or grade, supporting diagnostic rather than prognostic utility. Whereas sHVEM, sCD160, and sLAG-3 showed no diagnostic value. Age, sex, and body mass index (BMI) had minimal influence on sIC levels. Receiver operating characteristic (ROC) analyses showed strong performance: sGal-9 was the best classifier (area under the curve (AUC) = 0.98; 91

Background: Upper tract urothelial carcinoma (UTUC) is a rare malignancy representing approximately 5-10% of all urothelial cancers. Key risk factors include smoking, chemical exposures, selected metabolic conditions, and hereditary cancer syndromes. This narrative review summarises current knowledge on UTUC molecular pathogenesis, major risk determinants, and contemporary therapeutic strategies. Methods: This study was conducted as a narrative review with a structured literature search. PubMed, Web of Science, Embase, and Scopus were searched using predefined combinations of UTUC-related terms covering molecular pathogenesis, carcinogenic risk factors, and treatment strategies. The review was prepared according to SANRA principles to improve transparency and consistency; however, no formal systematic review methodology or meta-analysis was performed. Results: Available genomic studies indicate that UTUC has a molecular profile distinct from urothelial bladder carcinoma (UBC), with recurrent alterations involving FGFR3, HRAS, KMT2D, CDKN2A, KRAS, MYC, and BRIP1. Smoking, aristolochic acid exposure, Lynch syndrome, and possibly early-onset urolithiasis contribute to carcinogenesis through distinct but incompletely understood mechanisms. Surgical treatment remains the standard of care for high-risk localised disease, whereas perioperative chemotherapy, immunotherapy, and targeted agents are expanding treatment options, particularly in advanced disease. A substantial proportion of the therapeutic evidence, however, is derived from broader urothelial carcinoma populations rather than UTUC-specific studies. Conclusions: UTUC is biologically heterogeneous and shaped by both molecular alterations and environmental exposures. Although substantial progress has been made, important gaps remain in understanding UTUC-specific carcinogenic mechanisms and in defining evidence-based personalised treatment strategies. Better integration of molecular, environmental, and clinical data is needed to improve risk stratification and treatment selection.

The comparative efficacy and safety of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) have been extensively evaluated in the general adult population; however, evidence specifically focused on older patients remains limited. Given the underrepresentation of older individuals in comparative studies and the lack of age-specific meta-analytic data, we conducted a systematic review and meta-analysis to evaluate and compare the efficacy and safety of RIRS versus PCNL in the geriatric population. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Comparative studies evaluating outcomes of RIRS and PCNL in older patients were identified through comprehensive searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library up to January 2026. Primary outcomes included overall, minor, and major complications, as well as stone-free rate (SFR). Subgroup analyses were performed according to the age thresholds used to define the geriatric population (≥ 60 and ≥ 65 years). Eight studies including 849 older patients (419 RIRS, 430 PCNL) were analysed. PCNL was associated with a significantly higher final SFR (OR 0.63, 95

Kidney injury molecule-1 (KIM-1) is a transmembrane glycoprotein expressed in injured proximal tubules and renal cell carcinoma (RCC). This study evaluated urinary (uKIM-1) and plasma (pKIM-1) concentrations in patients with clear cell RCC (ccRCC) as potential diagnostic and prognostic biomarkers. A prospective observational study included 73 patients undergoing nephrectomy for renal tumors and 34 healthy volunteers. KIM-1 levels were measured using ELISA and analyzed in relation to tumor size, TNM stage, WHO/ISUP grade, and histopathological features. Diagnostic performance was assessed using ROC curves. Correlations were evaluated using Spearman coefficients. Both uKIM-1 and pKIM-1 levels were significantly higher in ccRCC patients compared to those with non-ccRCC tumors and healthy individuals (p < 0.001). pKIM-1 > 75 pg/ml demonstrated high diagnostic performance for ccRCC (AUC = 0.93, sensitivity = 90.4

Objectives: The impact of renal ischemia during partial nephrectomy (PN) on postoperative renal function remains controversial. On-clamp PN provides improved surgical exposure and haemostasis but induces warm ischemia, which may impair renal function. Off-clamp PN avoids ischemia-related injury and may better preserve renal function, although concerns persist regarding blood loss and oncological safety. We systematically compared perioperative and functional outcomes, as well as surgical margin status between on-clamp and off-clamp PN. Methods: We performed a systematic search of PubMed, Embase, Cochrane, Web of Science, and Scopus to identify randomized controlled trials (RCTs) and observational studies comparing on-clamp versus off-clamp PN with no publication time limitations. Outcomes included estimated glomerular filtration rate (eGFR), percentage eGFR change, estimated blood loss (EBL), transfusion rates, positive surgical margins (PSMs), operative time, and complications. Results: Thirty-nine studies (four RCTs) including 10,154 patients were analysed. Off-clamp PN was associated with a smaller decline in eGFR (mean difference [MD] -4 mL/min/1.73 m2, 95% CI -5.7 to -2.8) and lower percentage eGFR loss (MD -1.7%, 95% CI -2.8 to -0.7). On-clamp PN was associated with lower EBL (MD -48 mL, 95% CI -72 to -25). Transfusion rates favored on-clamp PN but were not statistically significant (OR 0.7, 95% CI 0.5-1.0). On-clamp PN was associated with a higher risk of PSM (OR 1.3, 95% CI 1.0-1.7) and postoperative complications (OR 1.3, 95% CI 1.1-1.6). Between-study heterogeneity and predominance of observational data were key limitations. Conclusions: Off-clamp PN provides superior renal functional preservation and lower risks of PSMs and complications, at the cost of increased blood loss. These findings support individualized surgical decision-making based on patient and tumor characteristics. What does the study add?: This study provides an extensive and detailed comparison of off-clamp versus on-clamp partial nephrectomy, encompassing more than 10,000 patients from 39 studies. By integrating the available evidence up to late 2024, it delivers comprehensive estimates of the renal functional benefits associated with ischemia-free surgery. Our findings delineate the trade-offs between renal preservation, blood loss, and surgical margin status, thereby informing individualised decision-making in nephron-sparing surgery and refining current understanding of when ischemia avoidance is most clinically advantageous. Patient summary: Our study suggests that performing partial nephrectomy without temporarily clamping the kidney blood vessels may better preserve kidney function and reduce cancer-related surgical risks, but can lead to increased blood loss during surgery. These findings indicate that the choice of surgical technique should be individualised, taking into account tumour features and patient-specific factors.

Introduction It is believed that bacteria can be involved in the formation of all types of stones. The aim of study was to assess the urinary microbiome in patients with urolithiasis. Material and methods The study group included 50 patients qualified for endoscopic treatment of urinary tract stones using: ureteroscopic lithotripsy (URSL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotripsy (PCNL), endoscopic combined intrarenal surgery (ECIRS). Before the procedure, patients were asked to collect urine and stool for analysis. Urine from the upper urinary tract and stone fragments were collected intraoperatively. The research material was subjected to 16S rRNA sequencing. The chemical composition of stones was assessed using Raman spectroscopy. Results In the urinary bladder, upper urinary tract, and kidney stone microbiomes of patients with urolithiasis the predominant bacteria identified were: Acinetobacter, Bifidobacterium, Corynebacterium, Cutibacterium, Paracoccus, Pseudomonas, Staphylococcus and Streptococcus. Further analysis showed the relative similarity of the urinary bladder and upper urinary tract microbiomes and the dissimilarity of the kidney stone microbiome. A comparison of the upper urinary tract microbiome based on the method of urine collection and a comparison of urinary bladder and upper urinary tract microbiomes based on the presence of a DJ stent prior to the procedure showed no statistically significant differences. Conclusions The microbiome of stones differs from the microbiome of urine, which may play a role in the pathogenesis of urolithiasis. Bladder urine and upper urinary tract urine microbiomes do not differ. Therefore, bladder urine can replace upper urinary tract urine in microbiome studies.

Cryoablation is gaining attention as a minimally invasive treatment option for prostate cancer (PCa), offering a balance between effective oncological control and preserving genitourinary functions and quality of life. Focal cryoablation is emerging as a viable option for patients with PCa, particularly those who prioritize functional outcomes such as erectile functions and urinary continence. Whole-gland cryoablation, on the contrary, may be more appropriate for intermediate- and high-risk PCa where complete ablation of the prostate is necessary to ensure oncological control. Despite promising results, there is considerable heterogeneity in the available data regarding the long-term oncological and functional outcomes of cryoablation techniques, making it premature to issue definitive treatment recommendations. Further studies, particularly randomized controlled trials, are needed to clarify the role of cryoablation in PCa treatment. This narrative review aims to present the most relevant and up-to-date evidence on both focal and whole-gland cryoablation in PCa, providing a comprehensive overview of their current clinical applications, outcomes, and future potential.

This study aimed to evaluate the impact of metastatic lymph nodes (LNs) outside the extended pelvic lymph node dissection (ePLND) template on oncological outcomes, staging, grading, and concomitant parameters in prostate cancer (PCa) patients undergoing radical prostatectomy (RP). Data from 860 patients with histologically confirmed, non-metastatic PCa who underwent RP between 2012 and 2022 were retrospectively analyzed. All specimens underwent detailed histopathological examination. Preoperative and postoperative clinicopathological data were collected and analyzed. Subgroup associations were evaluated using the Mann–Whitney U test and the Kruskal–Wallis test. Kendall’s tau-b coefficient was employed to evaluate the association between two variables. All tests were performed using a two-tailed approach, with a p value of less than 0.05 considered statistically significant for differences between groups. Kaplan–Meier and Cox regression analyses assessed biochemical recurrence (BCR)-free survival based on lymph node invasion (LNI) (pN0 vs. pN1) and the presence of metastatic LNs outside the ePLND template. Of the 860 patients, 613 underwent modified-ePLND. Among them, 122 (19.9

Despite advances in prophylaxis, early diagnosis, and treatment, urogenital cancers represent a significant challenge to public health in Poland due to their relatively high prevalence and mortality rates. This narrative review aims to explore contemporary evidence on the epidemiology of urogenital cancers in Poland, such as prostate cancer, bladder cancer, kidney cancer, testicular cancer, and penile cancer, focusing on current and historical status and trends in the broader context of healthcare delivery. The literature consistently indicates that urogenital cancer continues to be a significant contributor to cancer incidence and mortality rates in Poland. Although the body of evidence is expanding, its quantity remains limited, primarily attributable to the scarcity of top-notch epidemiological investigations targeting particular forms of cancer, such as testicular and penile cancers, which are characterized by sporadic occurrences.

BACKGROUND AND OBJECTIVE:Upper tract urothelial carcinoma (UTUC) is associated with poor survival. Recent studies have evaluated whether the presence of histological subtypes or divergent differentiation (HS/DD) is associated with worse UTUC prognosis. Our aim was to assess the relationship between HS/DD and clinicopathological features and oncological outcomes for patients with UTUC undergoing radical nephroureterectomy (RNU) without investigating causal pathways. METHODS:A literature search was conducted in September 2024. Patients with UTUC who underwent RNU were included. The main outcomes were differences in clinicopathological features and oncological outcomes between HS/DD and pure urothelial carcinoma (PUC) groups. KEY FINDINGS AND LIMITATIONS:We included 22 studies involving 14 407 patients in our review. HS/DD was present in 14% of tumours. In comparison to PUC, the HS/DD group had significantly higher rates of ≥pT3 stage, high-grade tumours, lymph node invasion (LNI), lymphovascular invasion (LVI), and receipt of adjuvant chemotherapy. Pooled results revealed that the HS/DD group had significantly worse cancer-specific survival (CSS) (hazard ratio [HR] 1.65, 95% confidence interval CI] 1.39-1.96), overall survival (OS; HR 1.84, 95% CI 1.52-2.22) ,and recurrence-free survival (RFS; HR 1.64, 95% CI 1.43-1.87). Intravesical RFS (IVRFS) and urothelial RFS (URFS) were comparable between the groups. CONCLUSIONS AND CLINICAL IMPLICATIONS:Our findings suggest that UTUC with HS/DD is associated with more advanced/aggressive features, such as higher pathological stage and grade, LNI, and LVI. HS/DD is associated with significantly worse CSS, OS, and RFS, but does not predict worse IVRFS or URFS. Therefore, HS/DD detection should prompt extensive treatment and closer follow-up. To improve the quality of recommendations and patient care, well-designed studies with central pathological review are needed.

Introduction:Urolithiasis is a highly prevalent disease influenced by a wide range of factors multifactorial etiology results in the formation of urinary stones with diverse mineral compositions. Accurate identification of stone constituents is crucial for effective prevention of recurrence. Gold-standard methods for stone analysis are not always readily available in clinical practice. To address this, Daudon proposed a morphological classification system aimed at identifying stone types based on their surface characteristics. However, existing literature reports suboptimal accuracy of this method, largely due to technical limitations of endoscopic equipment. The primary objective of this study was to evaluate the reliability of morphological assessment in predicting stone mineral composition. Secondary aims included the identification of factors contributing to the consistently poor accuracy reported in previous studies. Material and methods:An online quiz consisting of 20 single-choice questions was developed, each accompanied by a high-resolution image of a urinary stone and five predefined answer options. The reference stone composition for each image was determined using Fourier-transform infrared spectroscopy. Participants' performance was evaluated based on the percentage of correct responses per individual and per question. The results of specialists and residents were compared using the two-proportion Z-test, with statistical significance set at p <0.05. Results:A total of 779 responses were collected, with an overall accuracy rate of 33.7%. The most commonly selected answers were respectively oxalates, phosphates, uric acid, cystine, and infectious stones. Subgroup analysis revealed accuracy rates of 36% among attending physicians and 32% among residents, with no statistically significant difference. Notably, two participants achieved a perfect score (100%), supporting the internal validity of the test. Conclusions:Detailed analysis revealed a wide distribution of scores, ranging from participants with only one correct response to those who completed the quiz with full accuracy. These results suggest that the consistently low diagnostic accuracy reported in the literature is more likely due to limited familiarity and lack of experience with the morphological classification, rather than inherent shortcomings of the system itself. The findings highlight the need for comprehensive endourology training programs focused on improving stone morphology recognition skills.

PURPOSE:Our goals were to assess the survival outcomes of adjuvant radiation therapy (aRT) vs observation with or without early salvage radiation therapy for cN0M0 pN1 prostate cancer (PCa) and to create a model for clinical decision-making. MATERIALS AND METHODS:We retrospectively identified 1103 patients with cN0M0 PCa with pN1 PCa after surgery (2000-2021) at 18 referral centers. Kaplan-Meier curves and Cox proportional hazards models were used. RESULTS:Overall, 670 patients (61%) had International Society of Urological Pathology (ISUP) 4 to 5, and the median number of positive nodes was 1. On multivariable analyses, ≥ 3 positive nodes (HR, 2.03, 95% CI, 1.22-3.37; P = .006) and ISUP 5 (HR, 1.92, 95% CI, 1.15-3.18; P = .01) were associated with an increased all-cause mortality. Based on pT stage, ISUP, and positive nodes, a 2 risk categories model was created. In men undergoing observation, 7-year disease-free survival was 27% (95% CI, 20.4-36) for low- to intermediate-risk and 11% (95% CI, 6.7-17) for high-risk patients; aRT had higher overall survival rates in the high-risk group (92%; 95% CI, 87-96 vs observation 84%, 95% CI, 77-90; P = .006). In interaction term analyses, aRT confirmed its protective effect on mortality in high-risk patients (HR, 0.28, 95% CI, 0.09-0.84, P = .024). Results were comparable when excluding men with PSA persistence. CONCLUSIONS:In cN0M0 pN+ PCa, aRT yields a survival benefit compared with observation with or without early salvage radiation therapy only in men with a high-risk disease based on unfavorable prognostic factors. We created a risk model to guide clinical decision-making in this setting.

Introduction:Prostate-specific membrane antigen (PSMA) radioguided surgery (RGS) is being tested to personalize lymph node dissection at radical prostatectomy and in the salvage settings. Material and methods:We conducted a narrative review using the MEDLINE database (via PubMed), selecting key publications on the intravenous administration of PSMA to investigate lymph node involvement during surgery. Results:This review provides an overview of the PSMA-RGS methodology and outcomes. The technique demonstrates high specificity, particularly in ex vivo settings, with a median ranging from 93.5% to 100%. However, sensitivity varies widely, with a median range of 50% to 100%, often limited by reduced detection of micrometastases. Detailed preoperative, perioperative, and oncological evaluations are summarized in tables. Conclusions:PSMA-RGS is feasible and safe in both primary and salvage settings. In appropriately selected patients, it may contribute to longer therapy-free survival (36 months) and prolonged biochemical recurrence-free survival (19 months).