BackgroundProstate-specific membrane antigen (PSMA)-based imaging has become an increasingly important diagnostic tool in prostate cancer, though limited by low surface expression of PSMA in some patients. Previous studies have demonstrated that dutasteride can induce PSMA expression in vitro and in vivo. This pilot study aimed to evaluate the impact of short-term dutasteride treatment on standardized uptake values (SUVmax) in PSMA PET imaging and the immunohistochemical expression of PSMA for the first time in humans.MethodsFour prostate cancer (PCa) patients underwent an initial PSMA PET/MRI of the prostate. Afterwards, all patients received 0.5 mg of oral dutasteride once daily for seven days. Subsequently, a second PSMA PET/MRI of the prostate and a template biopsy were performed. We compared the maximum standardized uptake value (SUVmax) of PSMA-positive lesions before and after dutasteride treatment. Additionally, histopathological specimens from PSMA-positive lesions and negative controls were analyzed for Gleason score and PSMA expression.ResultsAn increase in SUVmax was observed in all patients following short-term dutasteride treatment. Histological analysis confirmed prostate cancer with an ISUP grade of ≥ 2 in PSMA-positive lesions that exhibited increased SUVmax following short-term stimulation. One PSMA-positive lesion, which showed a decrease in SUVmax after stimulation, was negative for prostate cancer on biopsy.ConclusionThis pilot study demonstrated an increase in SUVmax in PSMA-positive prostate cancer lesions following a short-term seven-day course of dutasteride. Short-term dutasteride treatment prior to PSMA-PET imaging may have the potential to enhance detection rates in patients with prostate cancer. Further studies are needed to investigate this effect in larger patient populations.

Advances in soft robotics, smart materials and bio-interfacing may enable the development of implantable artificial muscles (IAMs) to replace or augment biological muscles. emPOWER, a UK Research Council engineering project, is initiating foundational technologies and proof of concept for IAMs. This expert opinion piece considers IAMs in the clinical context of stress urinary incontinence. Conceptually, autologous sling tensioning by an IAM can adjustably restore urethral closure to resist fluctuations in intra-abdominal pressure. This could facilitate sling tension adjustment postoperatively, and patient control when the user anticipates greater physical need. Tailoring an IAM procedure to the individual patient's needs requires considering how to deliver the best pelvic floor configuration when upright and the extent of urethral compression necessary. emPOWER addresses both the development of IAM technologies and the needs of the patient, and has developed proof-of-principle working models for prototype contractile mechanisms (actuators). IAM innovation must meet Idea, Development, Exploration, Assessment, Long-term study for Devices (IDEAL-D) requirements and minimise the risk of complications, notably those associated with transvaginal mesh surgery. Accordingly, an IAM for treating stress urinary incontinence needs to minimise the amount of artificial material used, and contact of such material with the urethra. Placement of the implant should use minimally invasive techniques, and reduce the risk of implant infection.

BACKGROUND AND OBJECTIVE:To present a summary of the 2026 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy & Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) Guidelines on the treatment of relapsing, metastatic hormone-sensitive and castration-resistant prostate cancer (PCa). METHODS:The Panel performed a literature review of new data, covering the time frame between 2023 and 2025. The Guidelines were updated and a strength rating for each recommendation was added based on a systematic review of the evidence. KEY FINDINGS AND LIMITATIONS:Risk stratification for relapsing PCa after primary therapy may guide salvage therapy decisions. The range of treatment options for metastatic PCa has broadened, including androgen receptor pathway inhibitors (ARPI), metastasis-directed therapy, PARP inhibitors and their combinations, as well as PSMA-based therapy. The recommendations in the EAU Guidelines are based on clinical evidence and do not account for variations in cost, reimbursement structures, or resource availability across healthcare systems. CONCLUSIONS AND CLINICAL IMPLICATIONS:The evidence in the field of relapsing, metastatic, and castration-resistant PCa is evolving rapidly. These PCa Guidelines reflect the multidisciplinary nature of PCa management. A full version is available from the EAU Guidelines Office or online (http://uroweb.org/guideline/ prostate-cancer/).

High-intensity focused ultrasound (HIFU) is an increasingly used, locally ablative therapy option in localized prostate cancer (PCa). Multiparametric MRI (mpMRI) is currently used for tumor delineation. However, up to 56% of patients will have recurrent disease, defined as International Society of Urological Pathology (ISUP) grade of 2 or greater on follow-up biopsies within 3 y. The objectives of this study were to evaluate recurrence and failure-free survival (FFS) rates in patients treated with HIFU after undergoing prostate-specific membrane antigen (PSMA) PET and to compare delineation and scoring for biopsy-proven lesions between imaging techniques (PSMA PET vs. mpMRI). Methods: This single-center retrospective cohort study included all patients who were scheduled for HIFU between June 2017 and May 2022 and underwent a PSMA PET scan within 6 mo before planned HIFU for initial therapy of low-risk or intermediate-risk PCa (primary HIFU) or local recurrence after radiotherapy (salvage HIFU). Outcomes assessed included FFS, defined as the absence of ISUP grade 2 or greater on follow-up biopsies, progression on imaging, or biochemical recurrence. Tumor detection on mpMRI and PSMA PET was compared using PRIMARY and Prostate Imaging Reporting and Data System (PI-RADS) 2.1 scores for patients with adequate mpMRI and PSMA PET within 6 mo of HIFU. Results: Of the 26 patients included in the cohort, 3 (12%) did not undergo HIFU after the PSMA PET scan because of PCa upstaging. Of the remaining 23 patients, 9 (39%) were treated for recurrent disease and 14 (61%) for primary disease. Over a mean follow-up time of 3.2 y, 15 patients (65%; 95% CI, 42.7%-83.6%) were free of disease at the last follow-up. Eight patients (35%) experienced recurrent or residual disease within 3 y. Image analysis was performed for 18 patients, for a total of 23 lesions, with mean PRIMARY and PI-RADS 2.1 scores of 4.1 (range, 2-5), and 3.3 (range, 2-5), respectively. Lesion detection was rated superior on PET over mpMRI for 12 lesions, whereas mpMRI was superior for 1 lesion. Conclusion: PSMA PET scans performed before HIFU identified 12% of patients who were unsuitable for treatment. The overall improved FFS rate and higher PRIMARY score, when compared with the existing literature, suggest a potential benefit of PSMA PET for tumor delineation.

Background/Objectives: The heterogenous nature of renal cell carcinomas (RCCs) is increasingly recognized. The purpose of this proof-of-concept pilot study was to evaluate correlations between multiparametric MRI (mpMRI)-derived and histopathological parameters in RCCs from spatially matched regions on both MRI and pathological examination to support targeted biopsy planning. Methods: In this prospective single-center pilot study, patients with solid renal tumors ≥2 cm undergoing nephrectomy were prospectively enrolled. Each patient underwent preoperative 3.0T-mpMRI including T2-weighted and pre-/post-contrast T1-weighted sequences, chemical-shift imaging, IVIM-DWI, and T1/T2*/R2 mapping. Tumor regions were defined jointly by a pathologist and radiologist, and identical regions of interest were assessed for each tumor region across all sequences to gain quantitative mpMRI-derived parameters. Histopathology provided quantitative regional fractions of viable tumor, fibrosis, hemorrhage, and cystic/necrotic components. Spearman's rank correlations and univariable linear regression assessed associations between mpMRI and histopathological parameters on a regional level. Results: Across 49 tumor regions in eight patients (65.3% clear cell, 34.7% papillary RCCs), the mean viable tumor fraction was 80.9% (SD 17.6). The viable tumor fraction showed inverse correlations with nephrographic and delayed phase signal intensity changes (rho = -0.59/rho = -0.51), T1 values (rho = -0.56), true diffusion coefficient D (rho = -0.47), and ADC (rho = -0.45), and a positive correlation with R2 times (rho = 0.55). Delayed and nephrographic phase signal intensity changes (R2 = 0.41/R2 = 0.39) were the strongest single exploratory imaging correlates of viable tumor fraction. Conclusions: These findings support the feasibility of quantitative mpMRI parameters to capture regional intratumoral heterogeneity in RCCs, thereby highlighting regions with high viable tumor burden, which may help to refine the imaging-based assessment of RCCs in the future.

Background:Most therapy options for castration-resistant prostate cancer (CRPCa) target the androgen axis. Human kallikrein-related peptidase (KLK) 2, a serine protease, is a downstream target gene of the androgen receptor (AR) involved in cancer progression, but also known to have an AR-independent function. Tissue KLKs, especially KLK2, are promising targets for therapy in advanced PCa because of their high PCa specificity and their correlation to the rising cancer grade and stage. By inhibition with the recombinant protease inhibitor MDPK67b targeting KLK2 and other trypsin-like KLKs including KLK4 and KLK14, we investigated the antitumor response and the influence on AR downstream target genes with MDPK67b in PCa cell lines in vitro. Methods:Human PCa cells were cultured in a charcoal-stripped media and treated with MDPK67b (0.75 mg/mL). Cell viability was measured by CellTiter-Glo luminescent assay, cell death by flow cytometry. Gene analysis of AR, PSA, and PSMA was performed by qPCR. Correlating protein levels were evaluated by immunoblotting and confirmed by immunocytochemical staining. Results:Treatment with 0.75 mg/mL MDPK67b led to a reduction of cell proliferation of 40% by day 5 in androgen-sensitive LNCaP cells. Immunostaining confirmed the decrease in cell proliferation by antibody labeling of Ki-67. Treatment induced apoptosis, which was visible by flow cytometry of annexin V in LNCaP cells. Further, MDPK67b induced a reduction in AR and PSA gene and protein expression but upregulated PSMA, a target for PCa imaging and therapy. Conclusion:Treatment with MDPK67b demonstrates a significant antitumor effect by relevant reduction in cell proliferation and upregulation of apoptosis in LNCaP cells. Blockage of secreted KLKs can downregulate the AR and thereby influence its downstream target genes like PSA and PSMA. Upregulation of PSMA can lead to a theranostic, that is, therapeutic and diagnostic, advantage in clinics in a CR setting. Therefore, inhibition of KLKs represents a promising and AR-independent approach to treat advanced and CRPCa. Trial Registration:ClinicalTrials.gov ID: NCT04644770.

BACKGROUND:Benign prostatic hyperplasia (BPH) is a common urologic condition in aging men, often linked to systemic inflammation and metabolic dysfunction. Emerging evidence suggests that the gut microbiome may contribute to prostate health and disease. Here we aim to explore potential associations between gut microbiota composition and clinical parameters, such as prostate volume (PV) and residual bladder volume (RBV). METHODS:This cross-sectional study analyzed stool samples from 28 patients undergoing transurethral surgery. Gut microbiota composition was analyzed using 16S rRNA gene sequencing. Patients were stratified into groups based on PV ( ≤ 40 mL vs. > 40 mL) and RBV ( ≤ 100 mL vs. > 100 mL). α-diversity (Chao1 and Shannon indices) and β-diversity (Jaccard distance) were calculated. Linear discriminant analysis effect size (LEfSe) was used to identify differentially abundant taxa between groups. RESULTS:No significant differences in gut microbial α- or β-diversity were observed between groups stratified by PV or RBV. Nevertheless, several specific bacterial taxa showed significant variation between groups. Methanobrevibacter smithii was markedly less abundant in patients with PV > 40 mL (p < 0.01). Similarly, patients with high RBV ( ≥ 100 mL) exhibited distinct gut microbial profiles compared to those with lower RBV, characterized by a reduced abundance of Collinsella and an increased abundance of Gastranaerophilales (both p < 0.01). CONCLUSION:Our findings suggest that while overall gut microbial diversity may remain stable, specific taxa are associated with prostate and bladder phenotypes, supporting the concept of a gut-prostate axis. Future research should focus on longitudinal studies to investigate how gut (and urinary) microbiota evolve alongside BPH and/or LUTS over time, with the goal of determining whether microbial signatures could serve as early indicators for symptomatic BPH.

Purpose:To evaluate the diagnostic performance of the Prostate Imaging after Focal Ablation (PI-FAB) score on multiparametric MRI in combination with volume-adjusted PSA density (vaPSA-D, derived from volumetrically assessed residual vital prostate tissue) for detecting in-field recurrence after HIFU ablation of localized prostate cancer. Methods:In this retrospective single-center study, 117 men treated with HIFU underwent follow-up mpMRI and prostate biopsies at 6 (n = 99), 12 (n = 74), and 36 (n = 52) months. PI-FAB scores and vaPSA-D were assessed independently. Diagnostic performance was evaluated using biopsy-based histopathology as the reference standard. Results:PI-FAB demonstrated good diagnostic performance, particularly at 36 months (AUC 0.92). vaPSA-D showed increasing accuracy over time (AUC 0.64, 0.82, 0.84 at 6, 12, and 36 months; overall 0.78), outperforming PI-FAB at 12 months. Integrating vaPSA-D into PI-FAB subgroups significantly enhanced recurrence assessment: PI-FAB 1: sensitivity/specificity 75%/79% (threshold 0.14 ng/ml); PI-FAB ≥ 2: sensitivity/specificity 65%/85% (0.18 ng/ml); PI-FAB 3: sensitivity/specificity 67%/90% (0.18 ng/ml). Conclusion:Both PI-FAB and vaPSA-D provide reliable recurrence assessment after HIFU, with complementary strengths: PI-FAB performs best at later follow-up stages, whereas vaPSA-D maintains high sensitivity throughout. Their combined application offers the most accurate evaluation of post-HIFU recurrence and may help reduce unnecessary biopsies.

BACKGROUND AND OBJECTIVE:To present a summary of the 2026 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines on screening, diagnosis, and treatment of clinically localised prostate cancer (PCa). METHODS:The Panel performed a literature review of all new data published in English, covering the time frame between May 2023 and 2025. The Guidelines were updated, and a strength rating for each recommendation was added based on a systematic review of the evidence. KEY FINDINGS:A risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. The use of multiparametric magnetic resonance imaging to avoid unnecessary biopsies is recommended. When a biopsy is considered, a combination of targeted and regional biopsies should be performed. A new five-tier EAU classification has been introduced. Prostate-specific membrane antigen positron emission tomography imaging is the most sensitive technique for identifying metastatic spread. Active surveillance is the appropriate management for men with low-risk PCa, as well as for patients with selected favourable intermediate-risk ISUP grade group 2 lesions. Local therapies are addressed, as well as the management of persistent prostate-specific antigen after surgery. A recommendation to consider hypofractionated radiotherapy in intermediate-risk patients is provided. Patients with cN1 PCa should be offered radiotherapy to the primary tumour combined with long-term intensified hormonal treatment. CONCLUSIONS AND CLINICAL IMPLICATIONS:The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. These PCa Guidelines reflect the multidisciplinary nature of PCa management.

Microbiomes have been linked to oncogenesis, e.g. the intestinal microbiome and colon cancer or HPV-associated cervical cancer. A connection between microbiomes of different body cavities and tumor oncogenesis was shown. The gut microbiome’s influence on bladder cancer was established, raising the question whether nearby microbiomes (rectum, vagina) also influence bladder cancer due to their proximity. Considering the influence of various body cavities and the broader microbial components, this systematic review aims to investigate differences in the bladder, vaginal, and intestinal microbiota—including bacterial, viral, fungal and archaea—between patients with bladder cancer and healthy controls. Databases (PubMed, Scopus, Embase) were searched until April 2022. Three types of studies were included: “(1) studies using bladder cancer and control groups (case-controlled studies) (2) studies that provided information on the presence or abundance of microbial taxa (3) studies that provided information on increased or decreased taxa in bladder cancer and/or control groups.". Risk of bias was assessed using the Newcastle Ottawa Scale. Fourteen studies (695 samples: 403 bladder cancer, 292 controls) were analyzed. Bacterial taxa that have been detected in at least two studies, the genera Geobacillus and Rubrobacter were more frequently in bladder cancer patients; while Streptococcus and Roseomonas were more prevalent in controls. No consistent taxa were identified across stool or bladder tissue samples. The microbiota in bladder cancer patients show significant variation across studies. Standardized methods and expanded investigations into viral and fungal components are needed to clarify the role of microbiota in bladder cancer.

Introduction DNA double-strand breaks (DSBs) are repaired via homologous recombination (HR) or the more error-prone non-homologous end joining (NHEJ). breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) are key genes in HR, and their mutations are associated with aggressive prostate cancer (PCa). While PARP inhibitors (PARPi) improve survival in BRCA-mutated PCa, their efficacy in late-stage disease is limited and often accompanied by serious side effects. This study aims to develop an in vitro model of BRCA-mutated PCa and evaluate the therapeutic potential of DNA-dependent protein kinase (DNA-PK) inhibitors that target the NHEJ pathway. Methods The genes BRCA1 and BRCA2 were targeted for knockout (KO) in lymphnode cancer of the prostate (cell line) [LNCaP] using clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 technology. The KO were assessed via Western blot analysis. Scramble LNCaP, BRCA1 KO, and BRCA2 KO cells were treated with the PARPi talazoparib, the DNA-PK inhibitor nedisertib and their combination. The impact on cell proliferation was evaluated using the CellTiter-Glo assay and synergy of the treatments was analyzed with SynergyFinder. Cytotoxic effects were measured by flow cytometry using an Annexin V-fluorescein isothiocyanate (FITC) apoptosis detection kit. The presence of DSB was quantified using immunofluorescence. Results BRCA2 and BRCA1 protein expression were successfully downregulated in the knockout (KO) cell lines. After two days of treatment with talazoparib and/or nedisertib, a significant decrease in cell proliferation was observed. Additive effects of the combination treatment were detected exclusively in the BRCA KO cells. These cells also exhibited significantly higher rates of necrosis after treatment compared to scramble cells and, DNA DSB were significantly more prevalent in the BRCA KO cells. Additionally, BRCA1/2 loss is inversely correlated with DNA-PK, with knockout leading to increased DNA-PK expression to support NHEJ. Conclusion BRCA knockout LNCaP models were established, exhibiting increased DNA-PK activity and indicating greater susceptibility to DNA-PK inhibition. Therapeutically targeting NHEJ presents a promising approach in treating BRCA-mutated PCa. Further in vivo investigations are required to assess the tolerability of this drug combination.

Background: Transurethral resection of the bladder (TURB) harbors a high-risk for postoperative bleeding, especially in patients requiring anticoagulation. Recently, direct oral anticoagulants (DOACs) have become a popular alternative to vitamin K antagonists (VKAs), though their impact on TURB complications remains unclear. Objectives: To assess the postoperative complications of TURB from patients taking DOACs and VKAs. Design: Retrospective cohort study. Materials and methods: We retrospectively identified anticoagulated patients undergoing a TURB at our institution between 2012 and 2022 and divided them into two groups: whether they received VKA or DOAC. Follow-up of each patient was performed for 3 months. Occurrence and time to event of postoperative bleeding and thromboembolic events were recorded. A multivariable regression analysis was performed to assess risk differences. Results: A total of 167 patients (11.7%) fulfilled the inclusion criteria, of which 102 patients (61.1%) received a DOAC and 65 patients (38.9%) a VKA. Postoperative bleeding led to re-catheterization in 13 (12.8%) DOAC and 6 (9.2%) VKA patients ( p = 0.49) and re-intervention in 7 (6.9%) DOAC and 4 (6.2%) VKA patients ( p = 0.86). Blood transfusions were administered to 3 DOAC patients (2.9%), none in the VKA group. No thromboembolic events were reported. Conclusion: TURB carries low morbidity in anticoagulated patients. Thromboembolic events and the need for blood transfusion are infrequent. No substantial difference between the postoperative bleeding risk of patients receiving DOAC or VKA was found. All bleeding complications occurred within 2 weeks, marking it a potentially safe point in time to restart the OAC thereafter.

Purpose: To explore the use of different, zonal-specific PSA density (PSAD) variants in combination with the Prostate Signal Intensity Homogeneity Score (PSHS) to improve the detection of clinically significant prostate cancer (csPCa) and thus potentially help in risk stratification and adequate patient selection for prostate biopsy. Methods: This retrospective, single-center study included patients with available PSA values who were suspected of having prostate cancer and underwent multiparametric MRI (mpMRI) in combination with a subsequent prostate biopsy. Histopathologic biopsy results served as reference standard. Whole-gland (PSAD-T), peripheral zone (PSAD-PZ), and transition zone (PSAD-TZ) PSA densities were computed based on MRI-derived volume assessment. The diagnostic performance of these PSAD variants in predicting csPCa was assessed using ROC analysis. Conditional inference trees were used to examine the value of combining PI-RADS, PSAD-TZ and PSHS. Results: Among the 297 patients included, 126 (42.4 %) were diagnosed with csPCa based on histopathologic biopsy results. PSAD-TZ demonstrated superior diagnostic performance (AUC 0.78) for csPCa prediction compared to PSAD-T (AUC 0.75) and PSAD-PZ (AUC 0.63). Conditional inference tree analysis revealed that patients with negative or indeterminate mpMRI (PI-RADS <= 3) and an elevated PSAD-TZ in combination with low PSHS scores (<= 3), which indicate increased background signal intensity changes of the peripheral zone, were at an elevated risk for a missed csPCa. Conclusions: Integrating PI-RADS, PSAD-TZ, and PSHS may enhance risk stratification for csPCa at biopsy, enabling more precise identification of patients at an elevated risk who may require further evaluation. This approach may consequently reduce false-negative MRI results and facilitate more precise decision-making regarding biopsy indications.

Purpose: To compare the diagnostic performance and image quality of a deep-learning-assisted ultra-fast biparametric MRI (bpMRI) with the conventional multiparametric MRI (mpMRI) for the diagnosis of clinically significant prostate cancer (csPCa). Methods: This prospective single-center study enrolled 123 biopsy-naive patients undergoing conventional mpMRI and additionally ultra-fast bpMRI at 3 T between 06/2023-02/2024. Two radiologists (R1: 4 years and R2: 3 years of experience) independently assigned PI-RADS scores (PI-RADS v2.1) and assessed image quality (mPI-QUAL score) in two blinded study readouts. Weighted Cohen's Kappa (kappa) was calculated to evaluate inter- reader agreement. Diagnostic performance was analyzed using clinical data and histopathological results from clinically indicated biopsies. Results: Inter-reader agreement was good for both mpMRI (kappa = 0.83) and ultra-fast bpMRI (kappa = 0.87). Both readers demonstrated high sensitivity (>94 %/>91 %, R1/R2) and NPV (>96 %/>95 %) for csPCa detection using both protocols. The more experienced reader mostly showed notably higher specificity (>77 %/>53 %), PPV (>62 %/>45 %), and diagnostic accuracy (>82 %/>65 %) compared to the less experienced reader. There was no significant difference in the diagnostic performance of correctly identifying csPCa between both protocols (p > 0.05). The ultra-fast bpMRI protocol had significantly better image quality ratings (p < 0.001) and achieved a reduction in scan time of 80 % compared to conventional mpMRI. Conclusion: Deep-learning-assisted ultra-fast bpMRI protocols offer a promising alternative to conventional mpMRI for diagnosing csPCa in biopsy-na & iuml;ve patients with comparable inter-reader agreement and diagnostic performance at superior image quality. However, reader experience remains essential for diagnostic performance.

Background The mitochondrial metabolism in prostate cancer (PCa) is of great importance due the unique metabolic shift from glycolysis to oxidative phosphorylation. In this study, we aimed to analyze the expression level of mitochondrial markers TOM20, DRP1 and OPA1 in benign and malignant tissue, to assess if these markers are associated with different grade and stage of PCa. Materials and Methods This study assessed TOM20, DRP1, and OPA1 expression in formalin-fixed, paraffin-embedded prostate tissue samples, including benign and malignant tissue specimen. Immunohistochemistry on tissue microarrays was conducted, with staining intensities scored semi-quantitatively. Statistical analyses evaluated associations with PCa grade and stage. A survival analysis for biochemical recurrence (RFS), overall survival (OS) and disease specific survival (DSS) was performed using multivariate Cox regression analysis to assess prognostic properties of the markers. Results In total, 527 patients were included in our analysis, which composed of 45 (8.5%) benign prostate hyperplasia (BPH) and 482 (91.5%) PCa samples (436 localized (90.5%) and 46 (9.5%) metastatic). Immunoreactivity for TOM20, DRP1 and OPA1 was strong in 2 of 43 (4.7%), 1 of 43 (2.3%) and 0 of 43 (0%) of BPH control tissue. Strong marker expression was significantly increased in radical prostatectomy specimen (TOM20: 111/371 (29.9%), DRP1: 89/373 (23.9%), OPA1: 60/371 (16.2%), p<0.001) and in metastatic tissue (TOM20: 22/42 (52.4%), DRP1: 14/42 (33.3%), OPA1: 21/41 (51.2%), p<0.001). None of the markers demonstrated prognostic properties for RFS, OS, and DSS. Conclusion A strong association between the expression of the mitochondrial markers TOM20, DRP1 and OPA1 and PCa aggressiveness was demonstrated. However, these markers were not found to be prognostic regarding RFS, OS and DSS. Future studies are needed focusing on the underlying mechanisms of the upregulation of mitochondrial metabolism in aggressive PCa and evaluate potential therapeutic implications.

Postoperative bleeding is a known complication following transurethral resection of bladder tumors (TURBT). Although factors like tumor size and anticoagulant use are associated with increased bleeding risk, no validated prediction tool currently exists. This study aimed to determine predictors and develop a clinical tool for preoperative bleeding risk assessment. We conducted a retrospective analysis of patients undergoing TURBT at the University Hospital of Zurich between January 2016 and November 2022. Bleeding events were defined by four criteria: hemoglobin drop of ≥ 4 g/dl, need for transfusion, gross hematuria requiring prolonged irrigation, or surgical revision for bleeding during hospitalization or within 2 weeks after dischargement. During this time period, 447 TURBTs were performed, of which 54 (12.1

PURPOSE:To validate the TARGET score for multiparametric MRI (mpMRI) following high-intensity focused ultrasound (HIFU) therapy and to compare its diagnostic performance to the PI-FAB score. METHODS:This IRB-approved retrospective, single-center study included 83 patients who underwent follow-up mpMRIs and subsequent prostate biopsies at 6, 12, and 36 months after HIFU therapy for localized prostate cancer (05/2014-10/2021). Two radiologists independently assessed TARGET and PI-FAB scores. Inter-reader agreement was assessed using Gwet's AC1. Diagnostic performance was analyzed for both scores using histopathologic biopsy results as the reference standard. RESULTS:Follow-up mpMRIs of 83 patients were evaluated. Inter-reader agreement was substantial to almost perfect for both scores (AC1 = 0.78-0.83/ 0.70-0.96; TARGET/PI-FAB, ranges across the different follow-up intervals). Both the TARGET and PI-FAB score demonstrated high overall specificities (TARGET: 92 %/89 %; PI-FAB: 90 %/90 % for Reader 1/Reader 2) and NPVs (87 %/81 %; 84 %/80 %). Overall sensitivities (55 %/35 %; 45 %/30 %) and PPVs (69 %/50 %; 60 %/50 %) for both scores were comparatively lower. No statistically significant differences in diagnostic performance were identified between the two scores and readers (p > 0.05). CONCLUSION:Both scores demonstrated comparable diagnostic performance particularly in excluding in-field clinically significant prostate cancer recurrence post-HIFU and thus may be valuable, non-invasive tools as part of comprehensive monitoring strategies after HIFU treatment. However, challenges in detecting local tumor recurrence after HIFU therapy persist and require further refinement and optimization of the scores.