It is unknown whether the historical survival disadvantage of African American metastatic prostate cancer (mPCa) patients persists in abiraterone and androgen receptor pathway inhibitors (ARPIs) eras. In Surveillance, Epidemiology, and End Results (SEER) database (2017–2021), African American and Caucasian mPCa patients aged 40–80 years treated across abiraterone (2017–2018) and ARPI (2019–2021) eras were identified. Age- and sex-matched controls were generated (Social Security Administration life tables and Monte Carlo simulation). Years of life lost (YLL) were quantified for mPCa patients and controls. Subsequently, propensity score matching (PSM) and multivariable competing-risks regression (CRR) models were used. In abiraterone era, YLL were 8.1 in African Americans vs. 5.4 in Caucasians (Δ: 2.7). In ARPI era, YLL were 4.6 in African Americans vs. 2.6 in Caucasians (Δ: 2.0). The 24-months cancer-specific mortality (CSM) was 30.3

INTRODUCTION:We estimated cancer mortality figures for 2026 in five major Asian countries and Australia, with a specific focus on prostate cancer. METHODS:We computed country- and sex-specific annual age-standardized mortality rates (ASRs) for all cancers combined and for the 10 most common cancer sites, using data from the WHO and the United Nations Population Division up to 2022 or the most recent available year. We predicted figures for 2026 and estimated the number of avoided cancer deaths in 1994-2026. RESULTS:Predicted mortality rates for all cancers combined in 2026 are favourable across all considered countries and in both sexes, with the largest declines expected in the Republic of Korea (-20.5% in males and -10.2% in females compared with 2020-2022). In 2026, the lowest predicted male rate is expected in the Philippines (72.1 per 100 000), and the highest one in Australia (92.3 per 100 000). Among females, the lowest predicted ASR (42.2 per 100 000) is in the Republic of Korea, whereas the highest one (74.1 per 100 000) in the Philippines. Trends are generally favourable for lung, stomach, colorectum, and other major neoplasms considered, except pancreas. Predicted prostate cancer mortality is favourable in all countries and across all age groups. Rates are expected to remain low in Hong Kong SAR, Japan, and the Republic of Korea, with ASRs below 4 per 100 000 males. Since the 1993 observed peak rate, an estimated 132 000 total cancer deaths were avoided in Hong Kong SAR, 75 000 in Israel, 1 366 000 in Japan, 720 000 in the Republic of Korea, 328 000 in Australia, and 102 000 among men in the Philippines. CONCLUSIONS:Declining cancer mortality is predicted in the countries considered. These trends largely reflect smoking cessation along with improvements in prevention, early detection, and treatment. However, substantial geographic disparities persist, highlighting the need for strengthened cancer control strategies, particularly in ageing populations.

To evaluate the association between time to biochemical recurrence (ttBCR) and cancer-specific mortality (CSM) after prostatectomy or radiotherapy. This population-based study included 3606 patients experiencing BCR after prostatectomy or radiotherapy in Stockholm, Sweden, between 2003 and 2019. We tested the association between ttBCR and CSM using Cox models adjusted for clinical and pathological characteristics and estimated conditional cancer-specific survival by ttBCR and EAU risk group. Among prostatectomy (n = 2392) vs radiotherapy patients (n = 1214), 589 vs 170 (25 vs 14

Background and rationale Acid Phosphatase 3 (ACP3) has emerged as a promising alternative theranostic target to Prostate-Specific Membrane Antigen (PSMA) in prostate cancer. Gallium-68 labeled OncoACP3 ([68Ga]Ga-OncoACP3), a high-affinity small organic radioligand for human ACP3, has shown encouraging properties in preclinical experiments. In this prospective Phase I study, we assessed the safety, the dosimetry, pharmacokinetics, and preliminary positron emission tomography (PET) imaging findings of [68Ga]Ga-OncoACP3. Methods Prostate cancer patients received a single administration of 250 (150–275) MBq of [68Ga]Ga-OncoACP3, followed by PET/CT scans at 0, 10, 60, and 120 min. Blood and urine samples were serially collected. Safety was assessed for up to 1 week after imaging. Adverse events were recorded and graded according to CTCAE v.5. Dosimetry was evaluated centrally based on PET/CT scans and blood and urine radioactivity measurements. Pharmacokinetics were assessed using serial blood samples. Uptake in lesions and healthy organs was evaluated visually and semi-quantitatively. Imaging findings were compared to PSMA PET, when available within 4 weeks, and histopathology data. Results A total of 20 patients were enrolled. No adverse events related to the administration of [68Ga]Ga-OncoACP3 were recorded. The whole-body effective dose was 1.91*10−2 mSv/MBq. [68Ga]Ga-OncoACP3 showed a mixed renal and hepatobiliary excretion, with rapid and selective tumour uptake. [68Ga]Ga-OncoACP3 PET/CT was positive in 17/20 patients and negative in 3/20 cases—all three cases also presenting a negative PSMA PET. Among patients whose final diagnosis was also confirmed histologically, [68Ga]Ga-OncoACP3 was true positive in 8/9 subjects. [68Ga]Ga-OncoACP3 demonstrated cleaner biodistribution than PSMA, with no salivary gland uptake visualisation and no unspecific bone uptakes. Conclusions [68Ga]Ga-OncoACP3 was safe. The dosimetry profile is consistent with that of other clinically used diagnostic radiopharmaceuticals. [68Ga]Ga-OncoACP3 showed optimal pharmacokinetics with rapid tumour uptake and clearance from healthy organs. [68Ga]Ga-OncoACP3 demonstrated promising characteristics for PET imaging of prostate cancer, supporting ACP3 as a clinically actionable theranostic target.

INTRODUCTION:Randomized trials demonstrated improved survival in metastatic prostate cancer (mPCa) with the adoption of several systemic therapies. However, real-world data validating this effect and quantifying its magnitude in years of life lost (YLL) according to race/ethnicity are unavailable. METHODS:In surveillance, epidemiology, and end results (SEER) database (2004-2021), Caucasian, African American, Hispanic, and Asian/Pacific Islander mPCa patients aged 40-80 years treated in androgen deprivation therapy (ADT, 2004-2012), docetaxel (2013-2016), abiraterone (2017-2018), and androgen receptor pathway inhibitor (ARPI, 2019-2021) eras were identified. Age- and sex-matched controls were generated (Social Security Administration life tables and Monte Carlo simulation). YLL were quantified for mPCa patients and controls. RESULTS:Overall, 36,658 mPCa patients were identified: 22,725 (62.0%) Caucasians, 6956 (19.0%) African Americans, 4785 (13.0%) Hispanics, and 2192 (6.0%) Asians/Pacific Islanders. In the ADT era, YLL values were 10.7 in African Americans, 9.0 in Hispanics, 8.4 in Caucasians, and 6.5 in Asians/Pacific Islanders. In the docetaxel era, YLL values were 9.4 in African Americans, 8.4 in Hispanics, 7.3 in Caucasians, and 6.2 in Asians/Pacific Islanders. In the abiraterone era, YLL values were 8.4 in African Americans, 6.3 in Hispanics, 5.4 in Caucasians, and 4.4 in Asians/Pacific Islanders. In the ARPI era, YLL values were 4.3 in African Americans, 3.6 in Hispanics, 2.7 in Caucasians, and 1.7 in Asians/Pacific Islanders. CONCLUSION:YLL values decreased with each novel treatment era, in all race/ethnicity groups. The most pronounced decrease in YLL values occurred with the introduction of ARPIs, in all race/ethnicity groups. Despite those survival advances, African Americans were invariably disadvantaged as evidenced by the highest YLL values.

BACKGROUND:Work-related musculoskeletal disorders are a growing concern in surgical practice, particularly in the context of robot-assisted surgery. Physical strain can significantly impact the well-being and performance of surgeons and surgical staff. This study aimed to evaluate the prevalence and severity of surgical strain among urologists using different available surgical platforms. METHODS:An anonymized, web-based survey was conducted between March and October 2024 using the REDCap platform. Distributed via professional networks and social media, the survey collected data on demographics, surgical experience, platform usage, and self-reported physical discomfort. Statistical analysis included Mann-Whitney U and Chi-squared tests, with P<0.05 considered significant. RESULTS:A total of 427 urologists participated. Most console surgeons (up to 83% for one robotic system variant) reported some level of physical discomfort. Discomfort was also reported by 83% of open surgeons and 80% of bedside assistants, the latter of whom had the highest incidence of injury (53%) from robotic arms. A noteworthy subset of survey respondents required physiotherapy (13-15%), medical (6-11%), or surgical (2-3.8%) interventions due to physical strain. No significant differences were observed by age or sex among console users. CONCLUSIONS:Ergonomic strain is prevalent among urologic surgeons, regardless of surgical platform, with bedside assistants particularly vulnerable. These findings underscore the need for ergonomic training, physical conditioning, and design improvements in surgical systems to safeguard surgeon health and maintain procedural efficacy.

INTRODUCTION:Non-clear cell renal cell carcinoma (nccRCC) comprises heterogeneous cancers historically managed using evidence extrapolated from clear cell RCC. Current guidelines support histology-guided treatment, but real-world adoption of systemic strategies and cytoreductive nephrectomy remains incompletely characterized. We assessed temporal trends in systemic treatment and cytoreductive surgery and identified predictors of treatment allocation in metastatic nccRCC. METHODS:We used the National Cancer Database to identify adults diagnosed with metastatic nccRCC from 2016 to 2022. Patients were classified as receiving targeted therapy (TT) only, immunotherapy (IO) only, IO + TT, or no documented systemic therapy. Temporal trends were assessed using annual treatment proportions and estimated annual percentage change (EAPC). Multivariable logistic regression evaluated predictors of systemic treatment allocation and receipt of cytoreductive surgery. RESULTS:Among 3677 patients, 30.9% received TT only, 19.3% IO only, 13.7% IO + TT, and 36.1% had no documented systemic therapy. Among treated patients, TT use decreased over time (EAPC -23.46%, 95% CI -25.80 to -21.05; P < .001), whereas IO only (EAPC +32.26%, 95% CI +6.21 to +64.71; P = .022) and IO + TT (EAPC +30.70%, 95% CI +25.00 to +36.66; P < .001) increased. Cytoreductive surgery declined (EAPC -8.89%, 95% CI -12.04 to 5.64; P = .001). Later year of diagnosis was associated with IO-based treatment, with differential use across histologic subtypes. CONCLUSIONS:Between 2016 and 2022, treatment patterns for metastatic nccRCC in the US shifted from TT toward IO-based regimens, while cytoreductive surgery declined, reflecting evolving real-world management of this heterogeneous disease.