Background/Objectives: Penile cancer carries a disproportionate burden of stigma and delayed presentation, with affected men increasingly turning to artificial intelligence (AI) chatbots as an anonymous information source. This study evaluated the quality, readability, understandability, actionability and clinical accuracy of AI chatbot responses to standardised penile cancer patient queries across six publicly available platforms. Methods: Fourteen standardised questions were submitted to ChatGPT-4o, Gemini, Perplexity, Microsoft Copilot, Claude, and DeepSeek, generating 84 responses. The responses were evaluated using DISCERN (information quality, scored 16–80), Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) (understandability and actionability, scored 0–100%), and Flesch–Kincaid grade level (reading complexity, recommended threshold ≤Grade 8). Between-platform and between-domain comparisons used the Kruskal–Wallis test with Dunn’s post hoc analysis. Clinical accuracy was assessed against the 2026 European Association of Urology-American Society of Clinical Oncology (EAU-ASCO) Collaborative Guidelines on Penile Cancer using a three-point ordinal scale across 10 guideline-scorable questions (maximum 20 points per platform); the four questions not addressed by the guidelines were scored separately for factual accuracy against authoritative external evidence. Results: No significant between-platform differences were identified for DISCERN (p = 0.796) or PEMAT-P understandability (p = 0.147). All platforms exceeded the 70% understandability adequacy threshold. Perplexity and Copilot demonstrated significantly higher actionability than all other platforms (100% vs. 75%, p < 0.001). No platforms achieved the recommended Grade 8 reading threshold, with Claude generating significantly more complex responses than ChatGPT-4o and Perplexity (grade 11.4 vs. 8.65 and 8.60, p < 0.05). Significant variation was identified across clinical domains for DISCERN (p < 0.001), Flesch–Kincaid grade level (p < 0.001), and word count (p < 0.001), with treatment-related questions achieving the highest information quality but also generating the most complex responses. Clinical accuracy scores ranged from 13/20 (ChatGPT-4o) to 16/20 (Copilot). Two critical errors were identified: Claude and DeepSeek both recommended bleomycin-containing chemotherapy regimens, directly contradicting the EAU-ASCO Strong recommendation against bleomycin due to pulmonary toxicity risk. Responses to the four survivorship and quality-of-life questions were factually accurate against external evidence in 23 of 24 cases. Conclusions: AI chatbot responses to penile cancer patient queries are broadly understandable but consistently fail to meet recommended readability thresholds and provide limited actionable guidance. Two platforms recommended bleomycin-containing regimens against an EAU-ASCO Strong recommendation; no platforms achieved full guideline concordance. Urologists should counsel patients on the limitations of AI chatbots as a health information source.

Prostate-specific membrane antigen (PSMA) is a surface membrane antigen that is highly overexpressed in prostate cancer, with heterogenous expression throughout the natural history of the disease. This has generated significant interest as a potential biomarker for use in early diagnosis and treatment of prostate cancer. We reviewed the literature surrounding PSMA and its current clinical applications in diagnosing and managing early prostate cancer that is confined to the prostate and local lymph nodes. A search on PubMed, Medline, and Web of Science was performed using the following keywords: "PSMA", "Prostate Specific Membrane Antigen", "Prostate cancer", "Biomarker", "Diagnosis". We considered all available articles relevant to the topic of PSMA as a biomarker in early prostate cancer when developing this narrative review. Key articles assessing the biology of PSMA, as well as its use as a potential diagnostic and therapeutic target in early prostate cancer, were assessed. The role of PSMA PET as a potential diagnostic and risk stratification tool was assessed. The current use of antibody-drug conjugates and radioligand therapy targeting PSMA was assessed, along with any current evidence to support their use in early prostate cancer. PSMA is heavily expressed throughout the early stages of prostate cancer, and this has significant therapeutic implications. There is a growing body of evidence that shows PSMA PET can play a role in the diagnosis, risk stratification, and prognostication of localised prostate cancer. PSMA-targeted therapies such as Lu-177 currently do not have any proven benefit in treating early prostate cancer; however, this remains an area of ongoing research.

This ‘How I Do It’ study provides a step‐by‐step video demonstration and discussion of relevant anatomical and pathophysiological considerations to safely replicate our novel two‐stage technique for nephrectomy and caval thrombectomy for level IV renal cell carcinoma complicated by Budd–Chiari syndrome.

OBJECTIVES:To summarise the impact of the coronavirus disease 2019 (COVID-19) pandemic on urological practice globally with a focus on Australian initiatives, as the pandemic resulted in radical changes in healthcare infrastructure and policies. METHODS:We conducted a literature review of the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE) and Web of Science medical databases. The key terms used to conduct our search algorithm comprised of 'COVID', 'wait list or wait time or delay', 'urology', 'surgery' and 'outcomes', and generated 231 articles. Abstracts were reviewed for relevance and 40 studies selected for full-text review. Society position statements and government level press release statements were identified through citation tracking and additionally included. RESULTS/DISCUSSION:The halt on elective surgical services during the pandemic was deemed necessary to curb infection rates and conserve healthcare resources. However, it resulted in extended wait times and large surgical backlogs with major downstream effects. Australia fared favourably with regards to infection rates compared to international populations consequent upon strict border control, vaccine mandates, and stringent lockdowns. However, similar trends were noted in both oncological and non-oncological urology service reduction, resulting in significant concerns regarding the long-term sequelae of delayed surgery and missed appointments upon patient clinical outcome. Initiatives including collaborative partnerships between public and private hospital sectors, government-funded programmes and adoption of telehealth were successfully established as part of Australia's efforts to stabilise our healthcare system in response to the pandemic. CONCLUSION:Australia's pandemic efforts have highlighted the escalating imbalance between increasing demand from a growing and ageing population on an already over-burdened system with finite resources. The additional strain of managing post-COVID-19 pandemic fallout in this context provides further challenges for clinicians and healthcare administrators alike. Collaboration by all stakeholders must continue in order to seek innovative solutions to maximise efficiency of healthcare service utilisation, so that quality universal healthcare provision may continue in the future.

OBJECTIVE:To provide a comprehensive review and analysis of guidelines from various professional and medical organisations regarding the use of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) as a staging scan for men with newly diagnosed intermediate-risk prostate cancer (PCa). MATERIALS AND METHODS:English-language guidelines and recommendations from the following associations and societies were reviewed and critically analysed: European Association of Urology (EAU), American Urological Association (AUA), National Comprehensive Cancer Network (NCCN), National Institute for Health and Care Excellence (NICE), Canadian Urological Association (CUA), American Society for Clinical Oncology (ASCO), Society for Nuclear Medicine and Medical Imaging (SNMMI). RESULTS:There is significant disagreement among guidelines regarding whether PSMA PET is a useful staging tool for men with a new diagnosis of intermediate-risk PCa. There is a stronger consensus that PSMA PET is useful in staging high-risk PCa. CONCLUSION:Whilst there is a growing body of evidence that supports the use of PSMA PET in newly diagnosed PCa, there is significant disagreement regarding its use for men with intermediate-risk disease. Recommendations are generally weak and based on expert opinions. This is an area of considerable ongoing research, and guidelines are likely to change as new evidence emerges.

Adenoid cystic carcinoma (AdCC) of the breast is a rare histological subtype of breast cancer, which usually has a low propensity for metastasis and is associated with a good prognosis. AdCC metastasis to the kidney is rare, with only 29 cases reported in the literature. We report a case of a woman in her 60s with multiple right-sided large cystic-solid renal lesions after a recent diagnosis of marginal zone B-cell lymphoma. The patient previously had T1c N0 breast AdCC, treated with curative intent surgery and adjuvant radiotherapy 10 years prior. She underwent a radical nephrectomy, and histology was confirmed asmetastatic classic AdCC, consistent with the spread from previous AdCC breast cancer. Although she was in remission for 10 years, it is imperative to distinguish between breast AdCC metastasis and primary cystic renal cell carcinoma to be able to formulate an optimal management strategy for these tumours.

Introduction: Imaging in renal cell carcinoma (RCC) is a constantly evolving landscape. The incidence of RCC has been rising over the years with the improvement in image quality and sensitivity in imaging modalities resulting in “incidentalomas” being detected. We aim to explore the latest advances in imaging for RCC. Methods: A literature search was conducted using Medline and Google Scholar, up to May 2024. For each subsection of the manuscript, a separate search was performed using a combination of the following key terms “renal cell carcinoma”, “renal mass”, “ultrasound”, “computed tomography”, “magnetic resonance imaging”, “18F-Fluorodeoxyglucose PET/CT”, “prostate-specific membrane antigen PET/CT”, “technetium-99m sestamibi SPECT/CT”, “carbonic anhydrase IX”, “girentuximab”, and “radiomics”. Studies that were not in English were excluded. The reference lists of selected manuscripts were checked manually for eligible articles. Results: The main imaging modalities for RCC currently are ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Contrast-enhanced US (CEUS) has emerged as an alternative to CT or MRI for the characterisation of renal masses. Furthermore, there has been significant research in molecular imaging in recent years, including FDG PET, PSMA PET/CT, 99mTc-Sestamibi, and anti-carbonic anhydrase IX monoclonal antibodies/peptides. Radiomics and the use of AI in radiology is a growing area of interest. Conclusions: There will be significant change in the field of imaging in RCC as molecular imaging becomes increasingly popular, which reflects a shift in management to a more conservative approach, especially for small renal masses (SRMs). There is the hope that the improvement in imaging will result in less unnecessary invasive surgeries or biopsies being performed for benign or indolent renal lesions.

This review aims to provide an up-to-date overview of the utility of artificial intelligence (AI) in evaluating prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scans for prostate cancer (PCa). A literature review was conducted on the Medline, Embase, Web of Science, and IEEE Xplore databases. The search focused on studies that utilizes AI to evaluate PSMA PET scans. Original English language studies published from inception to October 2024 were included, while case reports, series, commentaries, and conference proceedings were excluded. AI applications show promise in automating the detection of metastatic disease and anatomical segmentation in PSMA PET scans. AI was also able to predict response to PSMA-based theragnostic and aids in tumor burden segmentation, improving radiotherapy planning. AI could also differentiate intraprostatic PCa with higher histological grade and predict extra-prostatic extension. AI has potential in evaluating PSMA PET scans for PCa, particularly in detecting metastasis, measuring tumor burden, detecting high grade intraprostatic cancer, and predicting treatment outcomes. Larger multicenter prospective studies are necessary to validate and enhance the generalizability of these AI models.

OBJECTIVE:To identify and address areas for improvement within the current surgical training model in Australia and New Zealand relating to family planning and inflexible training as top barriers to gender equity in surgery. METHODS:A cross-sectional study of accredited surgical trainees and early career surgeons in Australia and New Zealand was conducted between September and October 2023. Participants were recruited by the RACS Fax Mentis, the Urological Society of Australia and New Zealand (USANZ) e-newsletter, and medical social media networks. Qualitative and quantitative data were collated by the electronic survey and thematically analyzed. RESULTS:There was a total of 146 participants. Approximately two-thirds of respondents identified as mothers and one-third as fathers, with representation from all surgical specialties. We identified four key themes including the disruptive impact of poor work-life balance on family planning, an absence of workplace systemic supports, a need for structured support program upon return-to-work from parental leave, and challenges in balancing professional and parental identities and responsibilities. CONCLUSION:To promote a culture of equity, inclusivity, and acceptance, restructuring of surgical training programs are necessary to support trainees as they navigate family planning and parenthood. Promotion of flexible training options and recruitment of additional clinical supports around parental leave period may reduce negative biases toward trainees simultaneously balancing family and work. Systemic change is required to lower barriers to entry and achieve gender equality in surgery.

Background/Objectives: Prostatic lymphoma is a rare malignant tumour that frequently causes urinary tract obstruction. It is uncommon for patients to present with systemic features or B-symptoms. As a result, it is often diagnosed incidentally during surgical lower urinary tract symptoms (LUTS) treatment. This systematic review aims to identify any common clinical features of prostatic lymphoma diagnosed incidentally during surgical LUTS treatment and summarise disease treatment and outcomes. Methods: The study protocol was registered with Prospective Register of Systematic Reviews (PROSPERO). A search was performed across the following electronic databases: MEDLINE, Embase, Web of Science, and Cochrane Database of Systematic Reviews. Full texts of eligible studies were analysed and data were extracted. The review was performed in accordance with PRISMA guidelines. Results: A total of 24 case reports compromising 25 cases were included. The median (IQR) age was 67 (61–73) years. All patients reported LUTS as their primary complaint, and the median duration of LUTS prior to diagnosis was 17 (4–44) months. Serum prostate-specific antigen (PSA) was normal in 10 cases and prostatomegaly present on imaging in 16 cases. A total of 10 different subtypes of lymphoma were reported. Extra-prostatic involvement was reported in eight patients. Chemotherapy, with or without adjuvant radiotherapy, was the mainstay of lymphoma treatment. The majority of articles reported positive outcomes, with complete remission in 17 cases. Conclusions: Prostatic lymphoma is a difficult clinical diagnosis due to its similar presentation to benign prostatic hyperplasia (BPH). Although rare, prostatic lymphoma may need to be considered as a diagnosis in patients with an atypical presentation of BPH. Prognosis is often favourable after prompt referral to haematology or oncology.