Importance:Prostate cancer (PCa) incidence and prognosis have changed substantially worldwide in recent decades, driven in part by early detection recommendations. Some countries such as the US have shown a rise in metastatic PCa incidence following recommendations against routine PCa screening around 2012. Objective:To evaluate trends in PCa incidence, mortality, and relative survival across age and prognostic groups and guide policy and practice in Switzerland. Design, Setting, and Participants:This cohort study included all registered cases of primary PCa based on data from the Swiss National Agency for Cancer Registration and the Swiss Federal Statistical Office from January 1, 1980, to December 31, 2021. Data were analyzed from January 8, 2024, until February 20, 2026. Exposure:Diagnosis of PCa. Main Outcomes and Measures:Age-standardized incidence and mortality rates and relative survival to 10 years after diagnosis were estimated. Subgroup analyses were conducted by age, Surveillance, Epidemiology, and End Results stage, Union for International Cancer Control stage, and Gleason score. Results:The study included 142 665 cases of primary PCa registered in Switzerland between 1980 and 2021, 100 102 (70.2%) of which were men aged 60 to 79 years. From 1980 to 2004, PCa incidence increased to 226.6 (95% CI, 218.8-234.7) per 100 000 men; it decreased markedly to 173.5 (95% CI, 168.9-178.2) per 100 000 men between 2011 and 2014, then increased again to 220.6 (95% CI, 216.0-225.3) per 100 000 men in 2021. These trends were primarily observed for localized, stage I to II PCa and PCa with a Gleason score of 7 or less in men aged 50 to 79 years. Incidence of distant and stage IV PCa increased after 2011, while incidence of PCa with a Gleason score of 8 to 10 remained relatively stable. PCa mortality declined continuously from the early 1990s to 34.8 (95% CI, 32.9-36.8) per 100 000 men in 2021, while 10-year relative survival increased from 46.2% (95% CI, 43.7%-48.8%) in 1982 to 1991 to 88.5% (95% CI, 86.6%-90.5%) in 2012 to 2021. The 10-year relative survival among men with localized PCa (99.2%; 95% CI, 96.0%-102.4%) was similar compared with men from the general population. Conclusions and Relevance:In this population-based cohort study, trends in PCa incidence in Switzerland suggest that overdiagnosis of lower-risk PCa increased and that there was a concurrent rise in cancers diagnosed in advanced stages alongside improvements in overall prognosis. These findings further suggest substantial potential for optimizing early detection of PCa.

Der schwache Harnstrahl stellt ein häufiges Symptom in der hausärztlichen und urologischen Praxis dar. Insbesondere bei Männern im mittleren und höheren Lebensalter. Etwa 30

To evaluate the impact of teaching during radical prostatectomy in a nationwide prospective registry, assessing whether teaching influences perioperative or pathological outcomes. Data were extracted from the Swiss Urology Prostatectomy Registry, a nationwide quality-monitoring program including all certified training centers. Teaching was defined as procedures performed by a supervised trainee as primary operator. Baseline and perioperative outcomes were compared descriptively, and multivariable regression models assessed associations between teaching status and perioperative and pathological outcomes. A total of 7,607 men underwent radical prostatectomy between 2020 and 2025, of whom 825 (10.8

INTRODUCTION:The landscape of diagnosis and treatment of locally advanced and metastatic prostate cancer has seen an unprecedented evolution in recent years. Incorporation of results from pivotal studies is crucial for state-of-the-art counselling of patients and to inform treatment recommendations. However, in daily practice ambiguous situations may occur or various options may seem adequate. Furthermore, specific national regulations, e.g. availability of diagnostic tools and drug approvals, may influence treatment choices. This paper presents the voting results of a Swiss expert panel that convened in August 2024 and discussed selected questions addressed by an international panel of experts during the Advanced Prostate Cancer Conference held in Lugano in April 2024. The objective is to facilitate national harmonization of diagnosis and treatment of locally advanced and metastatic prostate cancer and thereby providing a basis for discussion with individuals with prostate cancer.

Background:Men after an initial negative transrectal ultrasound (TRUS)-guided prostate biopsy have a low risk of prostate cancer (PCa) diagnosis and mortality during follow-up. It is unknown whether an initial negative multi-parametric magnetic resonance imaging (mpMRI)-guided biopsy is associated with the same risk of PCa diagnosis and mortality during follow-up. The present study aimed to describe the risk differences of developing localized, metastatic or deadly PCa after either a negative TRUS or mpMRI-guided prostate biopsy. Methods:Men after an initial negative prostate biopsy at our institution between 2005-2021 were retrospectively identified and divided into two groups, whether they received an mpMRI prior to the biopsy [magnetic resonance imaging (MRI) group] or not (no MRI group). Categorical and continuous variables were compared by t-tests. Results:A total of 1,308 men underwent an initial negative prostate biopsy (84% TRUS; 16% MRI). Re-biopsies were significantly more often performed in the no MRI group (P value <0.001). The incidence rate (IR) of PCa (grade group ≥2) were 9.8 per 1,000 person-years (py) in the no MRI group and 11.9 per 1,000 py in the MRI group (P value =0.50). No metastasis or PCa specific deaths were recorded in the MRI group, whereas the IR were 1.19 and 0.17 per 1,000 py in the no MRI group. Conclusions:Men with an initial negative biopsy have a low risk of developing localized, metastatic, or deadly PCa during long-term follow-up. The biopsy technique was not significantly associated with different IRs of significant PCa diagnoses. The event rates of metastasis and PCa-specific deaths were too rare to draw any conclusions.

Background and objective: Observation remains the recommended management approach for low-risk prostate cancer (PCa), aiming to balance oncological control and avoidance of overtreatment. This study investigated the use of observation and its association with patients’ socioeconomic position (SEP), age, and prostate-specific antigen (PSA) level on treatment choice in Switzerland. Methods: This cohort study analyzed Gleason score 6 PCa diagnoses in 2020 and 2021 from the Swiss National Agency for Cancer Registration dataset. Variables included age, PSA value, residence, and treatment codes. Municipality-based SEP deciles were linked to patients. Multivariable regression assessed the associations between SEP and observational management. Key findings and limitations: Of 4296 men, 2876 (65.4%) received observational management, 792 (18.0%) underwent active treatment, and management was unknown in 728 (16.6%). Compared with men from low SEP areas, those from middle (odds ratio [OR] 1.11, 95% confidence interval [CI]: 0.92–1.35) and high SEP (OR 1.29, 95% CI: 1.06–1.58) areas had higher odds of observation. Men aged 60–70 yr (OR 1.53, 95% CI: 1.24–1.89) and >70 yr (OR 2.10, 95% CI: 1.68–2.62) were more likely to undergo observation than those aged <60 yr. PSA 5–10 ng/ml (OR 0.67, 95% CI: 0.55–0.82) and >10 ng/ml (OR 0.60, 95% CI: 0.46–0.78) were associated with lower odds of observation compared with PSA <5 ng/ml. Conclusions and clinical implications: Most men diagnosed with localized low-risk PCa in Switzerland underwent observational management as the primary strategy in 2020 and 2021. However, at least 18% of men still received active treatment. Lower SEP, younger age, and higher PSA values were risk factors for active treatment within low-risk PCa patients. Patient summary: We looked at how men in Switzerland with low-risk prostate cancer were treated in 2020 and 2021. We found that most men chose observation instead of immediate treatment, but men with lower socioeconomic position, younger age, or higher prostate-specific antigen levels were more likely to have active treatment. This suggests that there are opportunities to reduce unnecessary treatment for certain patient groups.

The management of high-grade renal trauma (HGRT) is challenged by the limitations of the American Association for the Surgery of Trauma (AAST) renal trauma grading system. To enhance predictive accuracy for bleeding control interventions, Keihani et al. introduced the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS) in 2019. This study aims to externally validate the MiGUTS nomogram using a South African Level 1 trauma center cohort with a unique penetrating predominant population. Data were collected retrospectively from June 2021 to December 2023 at Tygerberg Hospital, encompassing all patients aged ≥ 18 years with AAST ≥ 3 renal trauma who underwent abdominal computed tomography imaging. Two blinded radiologists reviewed each scan. The nomogram incorporated trauma mechanism, hypotension/shock, concomitant injuries, vascular contrast extravasation (VCE), pararenal hematoma extension, and hematoma rim distance (HRD). Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUC) and its 95

BACKGROUND AND OBJECTIVE:While whole-gland therapies for localized prostate cancer (PCa) offer excellent oncological outcomes, these can impact patients' quality of life (QoL) through serious side effects. Focal therapy using high-intensity focused ultrasound (HIFU) has emerged as a less invasive alternative to preserve QoL. However, data on the psychological impact of HIFU remain rare. This prospective study evaluates health-related QoL and emotional burden over 36 mo in men undergoing focal HIFU. METHODS:In this prospective, single-arm, phase 2 trial (NCT02265159), 91 men with localized PCa (International Society of Urological Pathology grade group ≤3 and prostate-specific antigen ≤15 ng/ml) were treated with focal HIFU. Psychological distress and QoL were assessed at baseline and 6, 12, and 36 mo after HIFU using the following questionnaires: Memorial Anxiety Scale for Prostate Cancer (MAX-PC; PCa-specific anxiety), Hospital Anxiety and Depression Scale (HADS; anxiety and depression), and Functional Assessment of Cancer Therapy-Prostate (FACT-P; health-related QoL). Clinically significant distress was determined using established cutoffs. KEY FINDINGS AND LIMITATIONS:The psychological burden was generally low throughout the study period. MAX-PC scores declined steadily over time. HADS anxiety and depression scores displayed a transient increase at 6 and 12 mo, but returned to baseline at 36 mo. At all time points, <3% of patients had scores above the threshold for clinically significant distress on the MAX-PC and HADS questionnaires. FACT-P scores remained stable and high, with no significant score changes in the total health-related QoL. CONCLUSIONS AND CLINICAL IMPLICATIONS:Focal HIFU treatment for localized PCa is associated with a low psychological burden and stable, high health-related QoL. These results demonstrate the enduring impact of this organ-sparing approach on both psychological and QoL outcomes.