Intraoperative cardiac arrest during robotic-assisted surgery is rare but poses challenges due to limited patient access and the need for undocking. Evidence on structured team training and system-specific factors affecting time to cardiopulmonary resuscitation (CPR) remains limited. This prospective single-center simulation study evaluated six multidisciplinary teams managing standardized cardiac arrest scenarios with the daVinci® and HugoRAS® system. Teams completed three simulations: an unannounced baseline scenario, a second scenario following structured debriefing and introduction of a standardized emergency flowchart, and a third scenario after 3–5 months to assess skill retention. Primary endpoint was time to CPR initiation. Secondary endpoints were protocol adherence and undocking time. Repeated training significantly reduced time to CPR (58.2 ± 26.2 s vs. 31.8 ± 8.9 s; p = 0.03) and improved compliance with the emergency flowchart (p = 0.03). While overall time to CPR initiation did not differ between robotic systems (daVinci®: 48.0 ± 23.5 vs. HugoRAS®: 43.2 ± 16.1, p = 0.6), undocking time was significantly shorter with the daVinci® compared to the HugoRAS® system (20.8 ± 2.4 s vs. 41.0 ± 7.5 s; p < 0.001). Undocking phase accounted for 48.9 ± 14.0

OBJECTIVES:To identify contemporary drivers of postoperative decision regret 1 year after radical prostatectomy (RP). PATIENTS AND METHODS:In this prospective, multicentre study, patients undergoing robot-assisted RP (RARP) or retropubic open RP (ORP) for localised prostate cancer at seven centres in Germany and Austria (2022-2024) completed questionnaires preoperatively and at 1 year postoperatively. Decision regret was assessed using the Decision Regret Scale (DRS). Functional outcomes were measured with European Organisation for Research and Treatment of Cancer quality of life questionnaire - 25-item prostate cancer specific (EORTC QLQ-PR25) symptom scores at 1 year postoperatively. Multivariable logistic regression identified predictors of high surgical decision regret (DRS score ≥10). Sensitivity was tested via propensity score matching (PSM). RESULTS:A total of 419 patients completed the surveys (58% RARP, 42% ORP) at 1 year postoperatively. Surgical decision regret was low (mean [SD] DRS score 9.0 [15.4]). Erectile dysfunction was the outcome that most patients self-reported as worse than expected (54% [221/404]), followed by urinary incontinence (23% [96/414]) and oncological cure (10% [39/397]) in a questionnaire on their retrospective perception. The ORP patients reported higher regret regarding surgical approach than RARP patients (mean [SD] DRS score 11.3 [17.1] vs 7.4 [13.9], P = 0.02). In a multivariate analysis, high urinary symptom burden (odds ratio [OR] 2.4, P = 0.009) and impaired sexual functioning (OR 2.8, P = 0.002) independently predicted high surgical decision regret whereas surgical approach and prostate-specific antigen recurrence did not. Sensitivity analyses via PSM confirmed these independent predictors. CONCLUSIONS:Surgical decision regret after RP is primarily driven by postoperative functional outcomes rather than oncological results or surgical approach. Optimising functional recovery and managing patient expectations are key strategies to reduce regret in prostate cancer surgery.

Objectives:This work aimed to investigate the role of surgeon experience on operating time and detection rate of clinically significant prostate cancer (csPCa) in a large contemporary cohort undergoing transperineal (TP) MRI-targeted prostate biopsy. Materials and Methods:We retrospectively reviewed patients who underwent TP MRI-guided prostate biopsies between 10/2018 and 04/2024. Patients with suspicious MRI lesions (PI-RADS 3, 4 and 5) formed the study cohort. All patients underwent MRI-targeted biopsies of suspicious lesions combined with a standard 12-core systematic biopsy. Caseloads-both total and in increments of 50 cases-were calculated for each surgeon. We employed univariable and multivariable Poisson regression models to analyse biopsy duration, and logistic regression models to assess csPCa detection. Results:Out of 3336 MRI-guided TP biopsies, 1148 (34%) involved PI-RADS 3, 1398 (42%) PI-RADS4 and 790 (24%) PI-RADS 5 as index lesions. Most patients (55%) had one suspicious lesion. The median caseload per surgeon was 63 (IQR [interquartile range]: 30-110). Biopsy duration significantly decreased after the first 50 procedures (13 min [95% CI: 10-18] to 10 min [95% CI: 8-15]) and plateaued thereafter. Multivariable Poisson regression demonstrated increased caseload independently associated with shorter biopsy duration (IRR 0.891 [95% CI: 0.833-0.899], p < 0.001). The overall csPCa detection rate was 43%, with no significant correlation to caseload. These findings were consistent across subgroup analyses based on PI-RADS score. Conclusions:This large, contemporary study demonstrated that biopsy duration decreased significantly after approximately 50 cases, indicating a learning curve without compromising the detection rate of csPCa.

Background/Objectives: Robot-assisted and open radical prostatectomy (RARP and ORP) are established procedures for localized prostate cancer, with comparable oncological and functional outcomes. Little is known about patients’ knowledge of both procedures. This study aimed to examine comparatively the informational behaviour and knowledge of patients undergoing ORP vs. RARP. Methods: This prospective, multicentre study included patients who underwent RARP or ORP prior to presurgery counselling. The questionnaires gathered information about patients’ information-seeking behaviours and their assessment of outcomes for RARP vs. ORP. We investigated risk factors for the misperception of procedure outcomes. Results: A total of 508 patients were included (307 RARP (60%); 201 ORP (40%)). The most common sources of information were outpatient urologists (84%), urologic departments (67%) and the internet (57%). Compared with ORP, RARP patients more often received the same amount of information about both procedures (60% vs. 40%, p < 0.001). Compared with ORP, RARP patients wrongfully considered their procedure to be superior in terms of oncological and functional outcomes. In the multivariable analysis, age > 66 years (OR 2.1, p = 0.02), no high school degree (OR 1.9, p = 0.04), unbalanced information search (OR 2.4, p = 0.02), RARP patient status (OR 8.9, p < 0.001), and treatment at a centre offering only one procedure (OR 3.5, p < 0.001) were independent predictors of misperception. Conclusions: RARP patients wrongfully considered their intervention to be oncologically and functionally more beneficial than ORP patients perceived it to be. This may be due to unbalanced sources of information. Urologists and surgical centres must address this misperception to enable patients to make informed decisions.

Prostate cancer (PCa) is the second most common type of tumor diagnosed in men and the fifth leading cause of cancer-related death in male patients. The response of metastatic disease to standard treatment is heterogeneous. As for now, there is no curative treatment option available for metastatic PCa, and the clinical tests capable of predicting metastatic dissemination and metastatic response to the therapies are lacking. Our recent study identified aldehyde dehydrogenases ALDH1A1 and ALDH1A3 as critical regulators of PCa metastases. Still, the exact mechanisms mediating the role of these proteins in PCa metastatic dissemination remain not fully understood, and plasma-based biomarkers of these metastatic mechanisms are not available. Genetic silencing, gene overexpression, or treatment with different concentrations of the retinoic acid (RA) isomers, which are the products of ALDH catalytic activity, were used to modulate the interplay between retinoic acid receptors (RARs) and androgen receptor (AR). RNA sequencing (RNAseq), reporter gene assays, and chromatin immunoprecipitation (ChIP) analysis were employed to validate the role of RARs and AR in the regulation of the transforming growth factor-beta 1 (TGFB1) expression. Gene expression levels of ALDH1A1, ALDH1A3, and the matrix metalloproteinase 11 (MMP11) and their correlation with pathological parameters and clinical outcomes were analysed by mining several publicly available patient datasets as well as our multi-center transcriptomic dataset from patients with high-risk and locally advanced PCa. The level of MMP11 protein was analysed by enzyme-linked immunosorbent assay (ELISA) in independent cohorts of plasma samples from patients with primary or metastatic PCa and healthy donors, while plasma proteome profiles were obtained for selected subsets of PCa patients. We could show that ALDH1A1 and ALDH1A3 genes differently regulate TGFB1 expression in a RAR- and AR-dependent manner. We further observed that the TGF-β1 pathway contributes to the regulation of the MMPs, including MMP11. We have confirmed the relevance of MMP11 as a promising clinical marker for PCa using several independent gene expression datasets. Further, we have validated plasma MMP11 level as a prognostic biomarker in patients with metastatic PCa. Finally, we proposed a hypothetical ALDH1A1/MMP11-related plasma proteome-based prognostic signature. TGFB1/MMP11 signaling contributes to the ALDH1A1-driven PCa metastases. MMP11 is a promising blood-based biomarker of PCa progression.

Einleitung: Belastungsinkontinenz nach radikaler Prostatektomie beeinträchtigt die Lebensqualität der Betroffenen erheblich. Studien zeigen ein Versorgungsdefizit der betroffenen Patienten im Umgang und der Therapie ihrer Belastungsinkontinenz. Ziel dieser Studie war es, den Gebrauch von Inkontinenzhilfsmitteln [zum vollständigen Text gelangen Sie über die oben angegebene URL]

We comment on the recent study by Fröhlich et al., which evaluated the influence of adherence to multidisciplinary tumor board (MDT) recommendations on oncological outcomes in high-risk prostate cancer patients following radical prostatectomy. While this study contributes valuable real-world data, we highlight several limitations. Notably, psychosocial factors influencing adherence, such as fear of toxicity and socioeconomic concerns, were not addressed. Additionally, selection bias may have influenced the observed benefits of adjuvant radiotherapy, warranting the use of propensity score methods in future analyses. Finally, the lack of improvement in overall survival despite better biochemical recurrence-free survival raises questions about the clinical relevance of surrogate endpoints. We advocate for broader, patient-centered approaches and methodological rigor in future investigations.

INTRODUCTION AND OBJECTIVE:Robotic-assisted surgery (RAS) is widely adopted across surgical fields, notably urology, but patient knowledge remains limited, often shaped by misconceptions. Previous research indicates factors like age, profession, and technology use influence RAS perceptions. This study investigates public knowledge, preferences, and misconceptions about RAS within a German cohort. METHODS:A cross-sectional survey at a university hospital's open house gathered responses from 339 participants prior to an RAS exhibition. The questionnaire assessed demographics, surgical preferences, and RAS knowledge. Statistical analyses, including t tests, chi-squared tests, ANOVA, and multivariate logistic regression, identified key associations. RESULTS:A total of 71% (234) of participants favored RAS over conventional surgery, yet misconceptions persisted in 38% (122), particularly among pensioners (48% (46), p < 0.01). Misconceptions were linked to a preference for conventional surgery (43% (52) vs. 19% (36), p < 0.01). Surgical preference emerged as a significant predictor of misconception. Concerns included surgeon skill (41%, 141) and machine malfunction (39%, 132), with younger participants fearing human error and older individuals fearing technical failure (p < 0.01). CONCLUSION:This local study reveals strong public support for RAS but underscores prevalent misconceptions, especially among older adults, suggesting that addressing misconceptions could foster acceptance and informed decision-making.

Background and objective:Multidisciplinary tumour boards (MTBs) play a critical role in prostate cancer management, but their time-intensive nature limits accessibility. This study evaluates machine learning (ML) algorithms for automating MTB recommendations in prostate cancer patients, focusing on multi-label classification for diagnostic and therapeutic decisions. Methods:A retrospective dataset of 1929 MTB recommendations from 2020 to 2024 was used for model development and validation at a single academic centre. Three ML algorithms-Decision Tree, Random Forest and K-Nearest Neighbours (KNN)-were trained to predict recommendations for PSMA-PET, conventional imaging, active surveillance and local therapy (radical prostatectomy or radiotherapy). Model performance was assessed using accuracy, precision, recall and F1-score. Key findings and limitations:The Random Forest model achieved the highest overall accuracy (66.3%, 95% CI 61.7-71%) and showed stable performance across most outcome categories. Predictions for local therapy were highly accurate (F1-score: 0.99), but model performance was lower for less frequent recommendations such as PSMA-PET and active surveillance, reflecting class imbalance and recent guideline changes. Limitations include moderate overall accuracy, retrospective single-centre design and the need for extensive manual data preprocessing. In addition, a high proportion of patients were eligible for multiple treatment options, which may limit the discriminatory value of certain outcomes. Conclusions and clinical implications:This study demonstrates the potential of ML to replicate MTB decision patterns in prostate cancer with reasonable accuracy. However, the current model requires further optimization before it can be considered for clinical application. It should be regarded as a proof-of-concept that highlights both the opportunities and the challenges of algorithm-based decision support in oncology. Future work should focus on improving model performance through multi-institutional data, prospective validation and continuous adaptation to evolving clinical guidelines.

BACKGROUND:Nonsteroidal anti-inflammatory drug (NSAID) use has been investigated as a modifiable risk factor for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). This study comprises a systematic review and meta-analysis examining the impact of perioperative NSAID use on rates of POPF after PD. METHODS:A Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-compliant systematic review was performed. Pooled mean differences (MD), odds ratios (OR), and risk ratios with 95% CIs were calculated. RESULTS:Seven studies published from 2015 to 2021 were included, reporting 2851 PDs (1372 receiving NSAIDs and 1479 not receiving NSAIDs). There were no differences regarding blood loss (MD -99.40 mL; 95% CI, -201.71 to 2.91; P = .06), overall morbidity (OR 1.05; 95% CI, 0.68-1.61; P = .83), hemorrhage (OR 2.35; 95% CI, 0.48-11.59; P = .29), delayed gastric emptying (OR 0.98; 95% CI, 0.60-1.60; P = .93), bile leak (OR 0.68; 95% CI, 0.12-3.89; P = .66), surgical site infection (OR 1.02; 95% CI, 0.33-3.22; P = .97), abscess (OR 0.99; 95% CI, 0.51-1.91; P = .97), clinically relevant POPF (OR 1.18; 95% CI, 0.84-1.64; P = .33), readmission (OR 0.94; 95% CI, 0.61-1.46; P = .78), or reoperation (OR 0.82; 95% CI, 0.33-2.06; P = .68). NSAID use was associated with a shorter hospital stay (MD -1.05 days; 95% CI, -1.39 to 0.71; P < .00001). CONCLUSION:The use of NSAIDs in the perioperative period for patients undergoing PD was not associated with increased rates of POPF.

The DETECT trial presented by Schilham et al. in The Journal of Nuclear Medicine constitutes one of the first prospective trials on prostate-specific membrane antigen (PSMA) radioguided surgery (RGS) in primary prostate cancer patients ([1][1]). Thus, we first would like to congratulate the authors

PDF, 34K, qRT-PCR primer sequences for SyberGreen qRT-PCR are listed

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Fleming, Andrew MD; Thomas, Jonathan Christian; Drake, Justin A MD; Glazer, Evan Scott MD, FACS; Deneve, Jeremiah L DO, FACS; Yakoub, Danny MD, PhD, FACS; Dickson, Paxton V MD, FACS Author Information

PDF - 84KB, AZD5363 activity in prostate cancer cell lines in vitro

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