Background: Prostate cancer (PCa) remains one of the most common malignancies among men worldwide, with lymph node invasion (LNI) serving as a critical prognostic factor influencing treatment decisions and outcomes. This study aimed to evaluate the prevalence of LNI and investigate associated risk factors in a cohort of intermediate-risk PCa patients. Methods: This retrospective cross-sectional study included intermediate-risk PCa patients treated at Imam Khomeini Hospital, Tehran, Iran, from 2019 to 2024, who underwent radical prostatectomy with pelvic lymph node dissection (PLND). Data were extracted from hospital clinical documents and compared between patients with and without LNI. The primary outcome was the prevalence of LNI, while the secondary outcome aimed to identify associated demographic, clinical, and pathological risk factors. Statistical tests such as univariate logistic regression and ROC curve analysis were used. Results: This study found a 12.10% prevalence ofLNI. Univariate analysis revealed significant associations between LNI and advanced clinical stage, higher Gleason score, greater core involvement, and elevated total prostate-specific antigen (PSA) (OR=1.33), with all P<0.05. In multiple logistic regression analysis, adjusting for confounders, only PSA remained an independent predictor. The receiver operating characteristic (ROC) analysis confirmed PSA's moderate diagnostic accuracy for LNI (area under the curve [AUC]=0.685, P<0.001), with an optimal cut-off of 16.52 ng/mL, 65% sensitivity, and 68% specificity. Conclusion: The results indicated that only total PSA remained an independent predictor. This finding highlighted total PSA as a key biomarker for assessing LNI risk in intermediate-risk PCa patients. Additionally, total PSA demonstrated moderate diagnostic accuracy in predicting LNI, supporting its clinical utility in risk stratification and decision-making.

Bladder cancer (BC) exhibits high inter- and intra-patient heterogeneity, limiting the efficacy of standard treatments and underscoring the need for personalized therapeutic models. We established patient-derived organoids (PDOs) from 31 clinical BC specimens, achieving an 80.65% success rate. These organoids preserved distinct morphological subtypes: solid, hollow, and mixed and retained stable proliferative capacity. Histological and molecular analyses confirmed that PDOs recapitulated key features of the parental tumors, including a hybrid basal-luminal phenotype with elevated CD44, GATA3, and LGR5 expression, and peripheral localization of CK20 and Uroplakin 3 A (UPK3A), indicating structural polarity and urothelial differentiation. Functional drug screening of early-passage PDOs revealed heterogeneous responses to standard-of-care (SOC) agents, cisplatin and gemcitabine, as well as the EGFR/HER2 inhibitor lapatinib. Notably, lapatinib enhanced chemosensitivity in a dose-dependent manner, even at reduced concentrations of standard agents. The most effective combinatorial regimens significantly impaired organoid viability and architecture, suggesting a synergistic effect. Drug response variability across PDO lines correlated with patient-specific clinical features, including tumor grade and recurrence status. These results demonstrate that BC PDOs faithfully model tumor heterogeneity and offer a robust platform for individualized drug response profiling. Our findings support the utility of PDOs for preclinical drug evaluation and precision oncology, particularly in identifying effective combination therapies such as lapatinib-enhanced chemotherapy.

Neoadjuvant chemotherapy (NAC) followed by radical cystectomy is the standard of care for muscle-invasive bladder cancer (MIBC), yet treatment response is highly variable and current clinical predictors are inadequate. Deep learning (DL) offers a data-driven approach for modeling complex medical data and may improve response prediction. The objective of this systematic review was to systematically evaluate the performance, methodological rigor, and clinical applicability of DL models for predicting treatment response to NAC in patients with MIBC. Following PRISMA 2020 guidelines, we systematically searched 14 databases and clinical trial registries for studies applying DL models to predict NAC response in MIBC. Eligible studies included those using imaging or omics data and reporting quantitative performance metrics. Methodological quality was assessed using Prediction model Of Bias Assessment Tool (PROBAST) and APPRAISE-AI framework. Twelve studies comprising at least 1,575 unique patients were included. Most employed convolutional neural networks (CNNs), with some integrating radiomics, transcriptomics, or large language models. Reported area under the receiver operating characteristic curves ranged from 0.69 to 0.89, with hybrid models consistently outperforming standard CNNs. While clinical relevance and data quality were generally strong, as assessed by APPRAISE-AI, reproducibility and external validation were frequently limited. Using PROBAST, risk of bias was low in several domains, but concerns persisted regarding outcome definition and analytical rigor. DL models, particularly those integrating imaging with radiomics or clinical features, demonstrate promising potential for predicting response to NAC in MIBC. However, methodological inconsistencies and limited external validation currently constrain their clinical translation. Future research should prioritize prospective, multi-center validation, and standardized multi-modal integration to enable safe and effective clinical deployment.

Prostatic stromal sarcoma (PSS) is an exceptionally rare mesenchymal tumor of the prostate. We present a case of high-grade recurrent PSS in a 49-year-old man, managed with complete surgical excision and successful organ preservation. This report is accompanied by a literature review highlighting diagnostic challenges, histopathological features, and evolving surgical approaches, including robotic-assisted techniques. By comparing our case with previously reported cases, we emphasize the importance of individualized treatment strategies and long-term follow-up in managing this aggressive malignancy.

Introduction: Recent studies suggest that COVID-19 may lead to the development or exacerbation of lower urinary tract symptoms (LUTS). This study aimed to investigate whether urinary symptoms could be early or persistent manifestations of COVID-19 and assess their relationship with demographic and clinical factors.Methods: In this prospective cohort study, 307 PCR-positive COVID-19 patients were enrolled. A Persian-translated version of the International Prostate Symptom Score (IPSS) questionnaire was used to evaluate LUTS before, during, and two weeks after hospitalization. Demographic data and clinical history, including BMI, age, and ICU admission, were also recorded.Results: LUTS significantly worsened during and after COVID-19. The most common symptoms during infection were urinary frequency and nocturia, while nocturia and incomplete emptying were most prominent after recovery. The severity of symptoms was significantly higher post-COVID-19, particularly in patients with higher BMI. Age did not correlate with symptom severity, but a significant association was found between BMI and increased urinary frequency. ICU-admitted patients experienced worsening in incomplete emptying, while ward patients had a more generalized worsening across all LUTS domains.Conclusion: COVID-19 is associated with exacerbation of LUTS, particularly frequency, nocturia, and incomplete emptying, both during the infection and after recovery. These findings suggest that LUTS should be considered a potential COVID-19-related symptom. Physicians, particularly urologists, should be aware of these symptoms and ensure appropriate follow-up for affected patients.

ABSTRACT Background and Aims Benign prostatic hyperplasia (BPH) is among the most common urologic conditions in elderly men, presenting with lower urinary tract symptoms. Prostatic artery embolization (PAE) is a recent interventional treatment for BPH. Methods This prospective single‐center study reviewed the results of cases that underwent PAE for BPH from 2020 to 2022. Inclusion criteria were men with BPH refractory to pharmacologic treatment or those experiencing persistent adverse effects from medications, who were not candidates for surgical management. Assessments were made using ultrasonography for prostate volume and the International Prostate Symptom Score (IPSS) before and at 3 and 12 months after PAE. The clinical success rate of PAE was assessed according to the Cardiovascular and Interventional Radiological Society of Europe Standards of Practice. Recurrence of symptoms and complications after PAE were also recorded. Results From a total of 46 included patients, clinical success was achieved in 93% at 3 months and 85% at 12 months. Complications occurred in eight (17.4%) cases, including five cases of erectile dysfunction and three cases of urinary tract infection. Eight (17.4%) cases had recurrent symptoms and required pharmacologic treatment, while seven (15.2%) needed surgery. The IPSS score dropped significantly at 3 months, with a mean difference of −16.2 (95% CI: −17.7 to −14.8) (p < 0.001), and at 12 months after PAE, with a mean difference of −13.5 (95% CI: −15.9 to −11.1) (p < 0.001). Prostate volume decreased significantly at 3 months, with a mean difference of −36.0 (95% CI: −43.0 to −29.0) (p < 0.001), and at 12 months, with a mean difference of −37.3 (95% CI: −43.7 to −31.0) (p < 0.001). Conclusion The findings of this study indicate that PAE is an effective therapeutic approach for patients with BPH, demonstrated by the low rates of adverse events and the absence of major complications.

Background: The discovery of risk factors that might predict the recurrence of non-muscle invasive bladder cancer (NMIBC) is essential. Objectives: Therefore, this prospective cohort study aimed at examining the association between bacteriuria and pyuria before bacillus Calmette-Guérin (BCG) installation and the occurrence of intravesical recurrence (IVR) in patients diagnosed with NMIBC. Methods: A total of 73 NMIBC patients undergoing transurethral resection of bladder tumor (TURBT) and BCG treatment were included. Pre-instillation urine samples were analyzed for pyuria and bacteriuria. Results: The findings of this study indicated that preoperative pyuria was present in 31 (42.5%) of the studied patients. Furthermore, a statistically significant association was detected between preoperative pyuria and preoperative proteinuria (P < 0.001), preoperative hematuria (P = 0.023), preoperative bacteriuria (P = 0.001), and muscle invasion (MI) (P = 0.028). The results of the univariate analysis indicated substantial associations between the variables of smoking, diabetes, carcinoma in situ (CIS), age, and IVR. Subsequently, a multivariate analysis indicated that diabetes (HR = 18.11, P = 0.004) and CIS (HR = 14.69, P = 0.039) had a statistically significant link with IVR. Conclusions: In conclusion, our study demonstrated that diabetes, CIS, and younger age were the sole independent prognostic factors for IVR. Furthermore, no statistically significant association was observed between pyuria, bacteriuria, and smoking with bladder tumor recurrence. The analyses revealed that pyuria emerged as a statistically significant predictive factor for IVR only among individuals without pre-instillation proteinuria.

ABSTRACT Background Current approach to clinically suspicious biopsy‐naïve men consists performing prostate MRI, followed by combined systematic (TRUS‐Bx) and MRI‐Ultrasound fusion biopsy (MRI‐TBx) in those with PIRADS score ≥ 3. Researchers have attempted to determine who benefits from each biopsy method, but the results do not support the safe use of one method alone. This study aims to determine the optimal approach in biopsy‐naïve men, according to their PSA levels. Methods and Results A retrospective chart review of clinically suspicious biopsy‐naïve men who underwent both TRUS‐Bx and MRI‐TBx was done. Prostate specific antigen (PSA) levels were compared between patients only positive for MRI‐TBx and those with positive TRUS‐Bx. Further, cancer cases were divided to < 10 and ≥ 10 PSA groups and the pathology results, obtained by each method, were compared. Out of 195 men, 36 were diagnosed with prostate cancer (PCa). PCa was diagnosed by both MRI‐TBx and TRUS‐Bx in 26 men, half of whom had PSA > 10 ng/mL. At PSA ≤ 10 ng/mL, PCa would have been missed in 4 men (11.1%) had MRI‐TBx not been done, and in 6 men (16.6%) had TRUS‐Bx not been done. Conclusion Despite attempts to perform only one biopsy method in men with clinical suspicion of prostate cancer, we propose that at least in men with PSA ≤ 10 ng/mL, both systematic and MRI‐targeted biopsies be performed.

Abstract Background Dendritic cells (DCs) play a crucial role in immunity. Research on monocyte‐derived DCs (Mo‐DCs) cancer vaccines is in progress despite limited success in clinical trials. This study focuses on Mo‐DCs generated from prostate cancer (PCA) patients, comparing them with DCs from healthy donors (HD‐DCs). Methods Mo‐DCs were isolated from PCA patient samples, and their phenotype was compared to HD‐DCs. Key parameters included monocyte count, CD14 expression, and the levels of maturation markers (HLA‐DR, CD80, CD86) were assessed. Results PCA samples exhibited a significantly lower monocyte count and reduced CD14 expression compared to healthy samples (p ⟨ 0.0001). Additionally, PCA‐DCs expressed significantly lower levels of maturation markers, including HLA‐DR, CD80, and CD86, when compared to HD‐DCs (p = 0.123, p = 0.884, and p = 0.309, respectively). Conclusion The limited success of DC vaccines could be attributed to impaired phenotypic characteristics. These observations suggest that suboptimal characteristics of Mo‐DCs generated from cancer patient blood samples might contribute to the limited success of DC vaccines. Consequently, this study underscores the need for alternative strategies to enhance the features of Mo‐DCs for more effective cancer immunotherapies.

Considering the importance of understanding COVID-19 prevalence and vaccine effectiveness in individuals dealing with bladder or prostate cancer, as well as the plausible adverse repercussions of immunization, this study was undertaken to as- sess the prevalence and vaccination rates of COVID-19 in this group of patients. Furthermore, the investigation seeks to evaluate potential adverse effects and the efficacy of vaccines in patients diagnosed with prostate and bladder cancer. In this cross-sectional study conducted from 2020 to 2022, we systematically extracted clini- cal and demographic information, COVID-19 diagnoses, clinical symptoms, and par- aclinical data from the bladder and prostate cancer registry at our institution. Our analysis encompassed assessing the frequency of COVID-19 infections, vaccination rates, and the occurrence of adverse effects associated with vaccination within this specific cohort. Among the 249 enrolled patients, COVID-19 infection was confirmed in 19.4% of bladder cancer patients and 16.6% of prostate cancer patients. A substan- tial majority, 81% (202 patients), had received vaccination, with the Sinopharm vac- cine being the preferred choice for the majority (90%). The study’s outcomes reveal a vaccine efficacy of 82% in individuals with bladder cancer, while displaying a higher efficacy of 96% among patients with prostate cancer. This study provides evidence supporting the efficacy of the SARS-CoV-2 vaccine in reducing COVID-19-associated complications and mortality, as well as its high efficacy in patients with prostate and bladder cancer.

BACKGROUND:Inflammation plays a crucial role in tumor development and progression, with inflammatory markers showing promise in predicting cancer prognosis. However, their significance in muscle-invasive bladder cancer (MIBC), especially in the context of neoadjuvant chemotherapy (NAC), remains poorly understood. This study aims to evaluate the prognostic utility of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and derived neutrophil-to-lymphocyte ratio (dNLR) for overall survival (OS) in bladder cancer (BC) patients undergoing radical cystectomy (RC) in the NAC era. PATIENTS AND METHODS:A retrospective review analyzed prospectively-collected data from our institutional BC registry, covering patients with MIBC undergoing RC with curative intent from March 1st, 2016, to December 31st, 2022. Blood samples were collected preoperatively to calculate NLR, PLR, SII, and dNLR. OS was defined from surgery to last follow-up or death. Statistical analyses included ROC curves, Kaplan-Meier Curves, and Cox proportional hazards regression models. RESULTS:A total of 187 patients with median duration follow-up of 14.7 month were included in this study and 50.8% experienced death. NAC was administered in 50.3% of cases. The ideal cut-off for dichotomizing NLR, PLR, SII, and dNLR was 1.76, 104.30, 410.66, and 1.30, respectively. In multivariable analysis each of these biomarkers emerged as an independent prognostic factor for predicting OS. The results showed a correlation between higher NLR, PLR, SII, and dNLR levels and a deterioration in OS. CONCLUSION:Elevated values of these inflammatory markers indicate poorer survival, highlighting their potential as indicators of disease aggressiveness. Identifying patients with elevated markers can help healthcare providers personalize treatment strategies, improving patient outcomes and survival rates.

Background: Kidney cancer in adults includes malignant tumors originating from the parenchyma and pelvis and is the most lethal urogenital cancer. Available data in Iran indicate that the incidence and pattern of this cancer are changing. Objectives: Our study aimed to present an updated incidence rate of kidney cancer in Iran and its 31 provinces and their trends, and climate zones distribution of the disease. Methods: In this study, the age standard incidence rate (ASIR) of kidney cancer based on provinces, age groups, and gender has been calculated using the available data in the national cancer registration system of the Ministry of Health from 2003 to 2016. Results: Overall ASIR of kidney cancer was 1.28 per 100,000 from 2003 to 2016. ASIR of this cancer in men has increased from 0.96 in 2003 to 3.66 in 2016 and similarly, reached from 0.61 in 2003 to 2.24 in 2016 in women. Fars, Yazd, Tehran and Isfahan provinces had the highest ASIR in Iran. Hot climate zones are associated with a higher incidence of kidney cancer while moderate climate is linked to the lower incidence rates in Iran. Conclusions: Although the incidence rate of kidney cancer in Iran and its provinces is low, the increasing trend is concerning particularly among men. Therefore, it is crucial to develop cost-effective screening tests and implement control and prevention programs in the high-incidence provinces.

A pH-sensitive shell-sheddable magnetic nanocarrier was prepared based on Fe3O4@SiO2 nanoparticles coated with polyethyleneimine (PEI) and polyethyleneglycol (PEG). The PEI was coated on Fe3O4@SiO2 nanoparticles through an electrostatic attraction and the PEG chains were connected to the PEI via pH-sensitive benzoic-imine bonds. The synthesized products and final nanocarrier were characterized with FT-IR, H-1 NMR, dynamic light scattering (DLS), zeta-potential, TEM, and vibrating-sample magnetometer (VSM). The PEI, as a middle layer, was used to load the curcumin (an anticancer drug) via van der Waals interactions and the shedding of PEG as a hydrophilic corona at the tumor pH (acidic) could induce the release of the drug. The curcumin loading content was found to be similar to 15% and curcumin-loaded magnetic nanoparticles (C-LMNs) showed more triggered release at the tumor pH (5.6) than physiological pH (7.4). In comparison to pure magnetic nanoparticles (MNs), the C-LMNs showed more cytotoxicity to human prostate cancer cell (PC-3) and also resulted in an increased rate of late apoptotic/necrotic PC-3 cells, assessed by flow cytometry analysis. In conclusion, the C-LMN as pH- and magnetic responsive nanocarrier showed good potential for targeted curcumin delivery in therapy of prostate cancer.

Objective: Infection is one of the common complications of post-prostate biopsy. Therefore, prophylaxis with fluoroquinolones and/or cephalosporins is recommended. We aimed to evaluate the prevalence of antibiotic-resistant bacteria isolated from rectal swabs in candidates for transrectal ultrasound-guided (TRUS) biopsy. The possible patient’s related risk factors attributing to resistance to antibiotics were also assessed. Methods: This cross-sectional study was performed on 126 male patients who were candidates for TRUS biopsy. Rectal swabs were collected and the samples were transferred to the laboratory in Amies transport medium during 2 hours and cultured on MacConkey agar with ciprofloxacin 1 mg/L and ciprofloxacin-resistant strains were identified. Kirby-Bauer disc diffusion method was used to determine the antibiotic susceptibility of the isolates. Results: In total, 59 bacterial isolates were obtained, which were Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, respectively, in terms of frequency. They showed the lowest resistance to levofloxacin. Smoking was associated with positive culture results. Age was a factor with a significant effect on carrying ciprofloxacin-resistant strains. Conclusion: Ciprofloxacin resistance was high in almost all strains, but post-biopsy infectious complications were very low. Level of evidence: Not applicable

Synovial sarcoma, a rare soft tissue malignancy typically arising from synovial tissue, primarily manifests in the extremities but it may uncommonly present in other locations such as kidneys. Primary renal synovial sarcoma is an uncommon sarcoma with high mortality and recurrence rates. Here, we present a teenage boy with primary renal synovial sarcoma who was referred to our institution.

Background: Prostate cancer is the most common malignancy in men, which is the second leading cause of cancer-related death. The prevalence of prostate cancer in Iran is lower than in Western and European countries. Objectives: Our study presents an updated incidence rate of prostate cancer in Iran and its provinces, displays its trends, and adds its spatial distribution to the literature. Methods: We investigate the age-standardized incidence rates (ASIRs) per annum of prostate cancer from 2003 to 2016 in Iran, using the data of the cancer registration available by the Ministry of Health and Medical Education. Crude incidence rates were calculated by dividing incident cases by the population of the whole country and each province which was available on the website of Iran Statistic Center. Age standardization was done by the World Health Organization (WHO) standard population and presented according to age and province. Results: The crude number of incident prostate cancer cases in Iran was 49 188 between 2003 and 2016. Age-standardized incidence rate of prostate cancer showed an increasing trend from 4.46 in 2003 to 18.44 per 100 000 in 2016. Mazandaran (29.57 per 100 000 in 2008) and Esfahan (27.5 per 100 000 in 2016 and 26.51 per 100 000 in 2015) were provinces with the highest reported ASIRs, while Sistan and Baluchestan province had the lowest mean of ASIR (1.59 per 100 000) in the period of the study. Conclusions: The incidence of prostate cancer displays an increase of more than 4 times at the end of the study period. However, the increase in coverage of data recording and greater access to diagnostic tests during these years are effective in the reported ASIRS, but the steep slope in the incidence trend of prostate cancer compared to other cancers in Iran shows its capacity to become one of the health problems that underscore the necessity of implementation of control and prevention programs, especially in high-incidence provinces.

Several self-inserted foreign bodies have been reported in the lower genitourinary system. We report a 27-year-old man with suprapubic severe pain, purulent discharge from the urethra, and dribbling. He had a history of psychotic disorders and inserting an ink chamber of a pen into the urethra. Imaging showed hydronephrosis and a large urinary stone in the bladder with no sign of foreign body. During open cystotomy, we found that bladder stone was attached to a plastic tube that was extended into the patient's urethra. In such cases, timely surgery to prevent urinary retention and psychological support are required.

BACKGROUND:The only beneficial treatment option for the management of inferior vena cava (IVC) tumor thrombus is complete tumor removal. The aim of this study was to report our experience in surgical and clinical outcomes in patients with tumor thrombosis in IVC.METHODS:A retrospective chart review of patients who underwent surgical resection of IVC tumor at our institution over the past 10 years was performed. The patients were identified using a prospectively maintained database.RESULTS:We identified 51 patients, the mean age was 53.4 ± 16.8 years, and 25.4% were female. They were divided into three groups based on tumor thrombosis level. Twenty patients (39.2%) required sternotomy, and cardiopulmonary bypass (CPB) was used in 19 (37.2%) patients, and 2 (3.9%) cases underwent coronary artery bypass graft. The perioperative complications were severe bleeding (3 patients), pulmonary embolism (2 patients), and duodenal perforation (1 patient). Three (5.8%) in-hospital deaths occurred, and all were due to severe abdominal bleeding. After a mean follow-up time of 46.5 ± 42.0 months, 29 (56.9%) patients were alive. The mean survival time was 75.2 ± 8.4 months. In multivariate analysis, higher age (p = 0.033) and male gender (p = 0.033) proved to be independent prognostic factors.CONCLUSIONS:Tumor thrombus extending to the IVC is a rare and challenging event. Although using CPB may be safe and result in long-term survival with acceptable function, excessive bleeding during surgery may limit the use of this method.

Background: Bladder cancer is one of the most common cancers worldwide and also in Iran. Understanding of bladder cancer epidemiology is of great value for policymakers and assists in the prevention and early detection of the disease. Objectives: The aim of the present study was to report national and subnational incidence trends of bladder cancer in Iran between 2003 and 2015. Methods: This study investigated the age-standardized incidence rates (ASIRs) per annum of bladder cancer from 2003 to 2015 in Iran using the data from the cancer registration system of the Ministry of Health and Medical Education of Iran. The crude incidence rates were calculated by dividing incident cases by the country and province population, which were provided by the Statistic Center of Iran. Age standardization was performed using the WHO standard population, and ASIRs were compared by age, sex, and province. Results: The ASIR of bladder cancer increased from 8.35 in 2003 to 13.57 in 2015 in men. The ASIR of bladder cancer also showed a mild increase in females, 2.12 in 2003 versus 2.86 in 2015. The province of Yazd had the highest rate of bladder cancer in men, and West Azerbaijan had the highest rate for women (15.13 and 7.79 per 100,000), while Sistan va Baluchestan and Ilam had the lowest ASIRs for men and women (3.01 and 0.96 per 100,000, respectively). Conclusions: The increasing trend of bladder cancer incidence in Iran, despite the clear decreasing global trend accompanying to ongoing aging of the population highlights the diseases as a potential health problem in the upcoming years in Iran. Therefore, it is necessary for health organizations to implement effective research and control programs in the country to prevent further increases in disease burden.