OBJECTIVE:To validate International Bladder Cancer Group (IBCG) definitions of Bacillus Calmette-Guérin (BCG)-unresponsive and BCG-exposed non-muscle-invasive bladder cancer (NMIBC) and assess prognostic heterogeneity across various BCG-failure types. PATIENTS AND METHODS:From a multicentre international cohort of 3806 BCG-treated patients, 591 who developed high-grade NMIBC recurrence following BCG between 2003 and 2024 were included. Progression-free survival (PFS) was the primary endpoint; cancer-specific (CSM) and overall mortality (OM) were secondary endpoints. Cumulative incidence functions, competing-risk models and multivariable Cox regression were used. RESULTS:Patients with BCG-unresponsive and BCG-exposed disease showed similar PFS, CSM, and OM (all P > 0.05). When stratified into five subgroups, prognosis varied: 5-year progression rates were 29% for BCG-unresponsive, 32.5% for late relapse (between 6 and 24 months) after adequate BCG, 30% for BCG-exposed with inadequate BCG (<24 months from induction), 6.2% for BCG-resistant, and 14% for very late relapse (>24 months since last BCG) (P < 0.01). In multivariable analysis, BCG-exposed after inadequate BCG (subdistribution hazard ratio [sHR] 3.42, 95% confidence interval [CI] 1.33-8.84), late relapse (sHR 3.74, 95% CI 1.59-8.78), and BCG-unresponsive (sHR 2.34, 95% CI 1.00-5.44) were associated with higher progression risks compared to very late relapse. Limitations include retrospective design and treatment heterogeneity. CONCLUSIONS:Under IBCG definitions, BCG-unresponsive and BCG-exposed NMIBC have similarly poor outcomes. A refined classification reveals prognostic heterogeneity, with late relapses after adequate BCG demonstrating outcomes comparable to BCG-unresponsive, and very late relapses conferring better prognosis.

Importance:Standard-of-care management of radiorecurrent prostate cancer (PCa) involves systemic therapy; however, some patients seek to avoid the adverse events (AEs) that are associated with androgen-deprivation therapy (ADT). Objective:To determine outcomes of local therapy without systemic therapy for radiorecurrent PCa. Data Sources:MEDLINE, Embase, Web of Science Core Collection, and Google Scholar were searched from inception up to May 2025. No date or language filters were used. Data were analyzed from June to November 2025. Study Selection:Prospective and retrospective studies were selected that investigated local salvage therapies without concomitant systemic treatment for locally recurrent PCa after definitive radiotherapy. Eligible studies provided ADT-free survival (ADT-FS) and/or metastasis-free survival (MFS). Authors were contacted for additional data. Data Extraction and Synthesis:This study was prospectively registered and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using Risk of Bias Assessment Tool for Nonrandomized Studies, version 2. Individual patient data were reconstructed from Kaplan-Meier curves or retrieved from authors. ADT-FS, MFS, and rates of AEs were pooled in a random-effects models. Main Outcomes and Measures:Main outcomes were ADT-FS and MFS, which were modeled as pooled summary Kaplan-Meier curves, and rates of severe or worse AEs, which were modeled as proportions. Outcomes were stratified by treatment method. Results:Thirty-one studies (4525 patients) were identified that assessed salvage high-dose-rate brachytherapy (HDR-BT; 336 patients), low-dose-rate brachytherapy (LDR-BT; 92 patients), stereotactic body radiotherapy (SBRT; 213 patients), radical prostatectomy (sRP; 1476 patients), cryotherapy (1621 patients), high-intensity focused ultrasonography (HIFU; 677 patients), or mixed methods (110 patients). Prospective studies comprised approximately one-fourth of the evidence (1055 patients); however, none were identified for sRP. Pooled 2-year and 5-year ADT-FS (2887 patients) were 76.8% and 55.2%, respectively. Pooled 2-year and 5-year MFS (3425 patients) were 90.4% and 75.2%, respectively. Rates of severe or worse AEs (2308 patients) ranged from 14% for LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, and 2% for cryotherapy. Risk of bias concerns primarily regarded patient selection. Limitations included a lack of randomized clinical trials. Conclusions and Relevance:The findings of this systematic review and meta-analysis suggest that local therapies alone have reasonable efficacy in well-selected patients with locally radiorecurrent PCa. ADT-free survival was maintained for more than three-quarters of patients at 2 years and more than half at 5 years. Approximately one in ten experience an early metastatic event. Rates of severe toxic effects were manageable, in particular for salvage HDR-BT, HIFU, SBRT, and cryotherapy.

Although prostate magnetic resonance imaging (MRI) enhances the detection of high-grade prostate cancer (PCa), its predictive role in active surveillance (AS) of favorable risk PCa is unclear. We examined the association between baseline MRI Prostate Imaging-Reporting and Data System (PI-RADS) score and Gleason Grade Group (GG) upgrade risk among patients managed with AS. We systematically searched eight databases to identify studies evaluating the association between baseline PI-RADS score and the risk of GG upgrade in patients managed with AS for PCa (PROSPERO: CRD42024567762). We pooled the hazard ratios (HR)using Hartung-Knapp random-effects meta-analysis models. We assessed the risk of bias using the ROBINS-I tool. We included eleven studies (n = 6309) in the meta-analysis. The risk of bias was moderate, attributed to the retrospective and unblinded design of seven included studies. Among studies reporting baseline PI-RADS, 2,640 patients (52.1

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

Keratins (CK) and desmosomal proteins are associated with prognosis in many cancers, and CK5, CK14 and CK20 are recognized as surrogate markers for molecular subtyping of muscle-invasive bladder cancer (MIBC). We analyzed the correlation between protein clustering and MIBC subtypes. We retrieved samples of muscle-invasive UC from patients treated with radical cystectomy without prior neoadjuvant therapy at two institutions. Immunohistochemical staining with tissue microarrays was performed for keratins (CK5, CK7, CK8, CK10, CK13, CK14, CK17, CK18, CK19, CK20), desmogleins (DSG2, DSG3) and desmocollin 3 (DSC3), and outcomes were evaluated using the H-Score. Molecular classification subgroups were defined according to CK5 and CK20 expression; for a subset of cases, the MDACC molecular classification was also available. Clinical data were retrieved from medical records. Hierarchical clustering with Euclidean distance, classification trees and principal component analysis was used for data visualization. We identified protein clustering patterns for luminal and basal subtypes in 232 analyzed samples. DSG2 groups were independent from DSC3 and DSG3 clustering in the luminal subtype. The molecular clusters were comparable in matched primary tumour and lymph node metastases (LNM) samples, and the protein expression correlated moderately with each other. CK5 (PT (90 [IQR 8.3–265, LNM (30.8 [IQR 6.7–155]; p = 0.011)), CK17 (PT (145 [IQR 42.5–222.5]),LNM (47.5 [IQR 14.2–110]; p = 0.005), DSG2 ( PT (55 [IQR 15–105]), LNM (32.1 (7.5–75.8)); p = 0.004), and DSC3 (PT (20.8 [IQR 0–71.7]), LNM (3.8 [IQR 0–43.3]; p = 0.013) expression were lower in LNM. Limitations include the absence of patients treated with neoadjuvant therapy and the risk of overfitting. We concluded that distinct keratin and desmosomal protein patterns are linked to cancer subtypes, and remain consistent in LNM. These findings indicate potential for keratins and desmosomal proteins to guide muscle-invasive bladder cancer subtype classification with possible prognostic implications, necessitating further research.

BACKGROUND AND OBJECTIVE:Outcomes after radical cystectomy (RC) for non-muscle-invasive bladder cancer (NMIBC) are generally favorable, but a subset experiences recurrence and cancer-specific mortality (CSM). Tools to identify high-risk patients remain limited. This study aimed to identify predictors of recurrence and cancer-specific and overall mortality in pathological NMIBC treated with RC. DESIGN, SETTING, AND PARTICIPANTS:Multicenter retrospective cohort of 1032 patients with pTis/pTa/pT1 N0 R0 disease who underwent RC (2000-2015) at nine centers. No patient received perioperative therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed using Cox and competing-risks regression. Discrimination assessed by Harrell's C-index. RESULTS AND LIMITATIONS:Median follow-up 45.2 mo. Lymphovascular invasion (LVI), present in 39 patients (3.8%), was independently associated with RFS (hazard ratio [HR], 2.37; 95% confidence interval [CI], 1.29-4.38; p = 0.006) and CSS (HR, 2.59; 95% CI, 1.31-5.10; p = 0.006). Pathological stage was not associated with RFS (p = 0.074). Age predicted OS (HR 1.06; p < 0.001). LVI-positive patients had higher 10-yr CSM (35.3% vs 13.7%; p = 0.002). Discrimination was modest (C-index 0.59). Limitations include retrospective design and low LVI prevalence. CONCLUSIONS:In patients undergoing RC for pathological NMIBC, LVI identifies a small subgroup at increased risk of recurrence and CSM, while pathological stage adds little. These findings support LVI-guided surveillance and trial enrichment, but no treatment recommendations can be drawn.

BACKGROUND:Dedicated tools estimating the risk of Bacillus Calmette-Guérin (BCG) failure among patients with high-grade (HG) non-muscle-invasive bladder cancer (NMIBC) are lacking. OBJECTIVE:To develop a risk model predicting the development of BCG-unresponsive disease (defined according to the International Bladder Cancer Group and European Association of Urology [EAU] guidelines) or progression in patients with HG NMIBC receiving adequate BCG therapy. DESIGN, SETTING, AND PARTICIPANTS:This retrospective multicenter study included 2211 patients who were BCG naïve with HG Ta/T1 NMIBC (±carcinoma in situ [CIS]) treated with adequate BCG therapy between January 2003 and December 2024 at 13 academic centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary end point was time to BCG-unresponsive disease or progression to muscle-invasive/metastatic cancer. Multivariable Cox regression identified independent predictors, and a weighted clinical risk score stratified patients into four risk groups. RESULTS AND LIMITATIONS:Independent risk factors included T1 stage (adjusted hazard ratio [aHR] 1.52, 95% confidence interval [CI] 1.10-2.11), persistent HG or T1 tumor at restaging transurethral resection (aHR 2.51, 95% CI 2.06-3.06), multifocality (aHR 1.46, 95% CI 1.22-1.74), concomitant CIS (aHR 1.46, 95% CI 1.21-1.77), and World Health Organization 1973/2004/2016 HG/grade 3 (aHR 1.56, 95% CI 1.24-1.94). Internal validation via 1000 bootstrap samples revealed minimal optimism (0.01) and good calibration. The model demonstrated superior discrimination compared with the European Organization for Research and Treatment of Cancer progression score and EAU 2021 stratification (Harrell concordance index 0.68 vs 0.61 vs 0.56); 5-yr BCG-unresponsive-free survival was 88%, 79%, 60%, and 49%, respectively, across increasing risk groups. CONCLUSIONS:We developed a risk stratification model for patients with HG Ta/T1 treated with adequate BCG therapy. This tool enables individualized assessment of BCG failure risk and may support clinical decision-making.

OBJECTIVES:The objective of the study was to explore the distribution of gepotidacin into prostate tissue by ex vivo microdialysis (MD) after a single oral dose of gepotidacin. METHODS:We developed and validated an ex vivo MD technique to quantify unbound gepotidacin concentrations in the interstitial fluid of human prostate tissue after a single oral dose of 1500 mg. Adult male patients scheduled for radical prostatectomy received gepotidacin at different timepoints before surgery. MD probes were inserted into prostate tissue immediately after surgical removal for sampling of tissue concentrations. Plasma samples were collected in parallel. Population pharmacokinetic (popPK) modelling was used to analyse the concentration data. RESULTS:Thirty participants were recruited, of whom 24 had at least one prostate MD sample with concentrations above the limit of quantification. A popPK model was successfully developed that described plasma and prostate gepotidacin concentration well. The model-predicted geometric mean of unbound area under the concentration-time curve from zero to infinity was 15 500 h∗ng/mL (geometric coefficient of variation (GCV): 15.7%) in both prostate and plasma (prostate penetration ratio = 1). The model-predicted geometric mean of the unbound peak concentration (Cmax) of 1340 ng/mL (GCV: 38.7%) was reached after 4.25 hours (range: 3.25-12.2 hours) in prostate tissue. The model-predicted geometric mean of unbound plasma Cmax of 2090 (GCV 48.2%) ng/mL was reached after 1.75 hours (range: 0.75-8.25 hours). Model-estimated median total apparent plasma clearance and terminal apparent volume of distribution were 65.0 L/h (GCV 15.7%) and 1310 L (GCV 11.2%), respectively. CONCLUSIONS:Ex vivo MD proved feasible for quantifying gepotidacin in human prostate tissue, interstitial fluid showing exposures comparable with plasma. However, defining pharmacokinetic/pharmacodynamic targets against relevant pathogens for bacterial prostatitis remains essential for predicting drug efficacy for treatment of this disease.

Introduction: Sarcomatoid dedifferentiation may be identified in both clear cell renal cell carcinoma (ccRCC) and non-clear cell RCC (nccRCC). Within the SEER database (2010-2021), we tested the effect of sarcomatoid dedifferentiation in first ccRCC and subsequently in nccRCC on cancer-specific mortality (CSM). Methods: Separate propensity score matching (PSM) and multivariable competing risks regression (CRR) analyses were first applied to ccRCC with vs. without sarcomatoid dedifferentiation and subsequently to nccRCC with vs. without sarcomatoid dedifferentiation. Results: Sarcomatoid dedifferentiation was present in 2496 (3.0%) of 82,146 ccRCC patients and in 501 (1.9%) of 26,584 nccRCC. In ccRCC, after 1:2 PSM, 2496 (100%) patients with sarcomatoid dedifferentiation vs. 4992 (6.2%) patients without sarcomatoid dedifferentiation were included. At 60 months, CSM was 45.7% vs. 33.6% in ccRCC patients with vs. without sarcomatoid dedifferentiation. In CRR sarcomatoid dedifferentiation independently predicted 1.6-fold higher CSM (HR 1.6, p < 0.001). In nccRCC, after 1:2 PSM 501 (100%) patients with sarcomatoid dedifferentiation vs. 1002 (3.8%) patients without sarcomatoid dedifferentiation were included. At 60 months, CSM was 41.7% vs. 28.1% in nccRCC patients with vs. without sarcomatoid dedifferentiation. In CRR sarcomatoid dedifferentiation independently predicted 2.0-fold higher CSM (HR 2.0, p < 0.001). Conclusion: Sarcomatoid dedifferentiation is invariably associated with higher CSM in both ccRCC and nccRCC. However, the detrimental effect of sarcomatoid dedifferentiation in CSM is more pronounced in nccRCC than in ccRCC.

INTRODUCTION:The effect of insulin dependence in type 2 diabetes mellitus (T2DM) on adverse in-hospital outcomes after nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) is unknown. METHODS:Descriptive statistics, propensity score matching (PSM), and multivariable regression models were applied to the National Inpatient Sample (2004-2019) UTUC patients treated with NU. T2DM was stratified between insulin-dependent (ID) and non-insulin-dependent (NID) subtypes. RESULTS:In 10,761 NU patients, rates of ID-T2DM, and NID-T2DM were 2.7% and 19.1%, respectively. During the study period, ID-T2DM rates increased from 0.1 to 4.2% (estimated annual percentage change [EAPC]: +11.8%, p < 0.001), whereas NID-T2DM rates increased from 13.6 to 18.0% (EAPC: +1.1%, p = 0.045). After PSM, ID-T2DM patients (294 vs. 588 nondiabetic controls) exhibited higher rates of blood transfusions (+4.9%) and genitourinary complications (+7.8%), as well as higher total hospital charges (THCs; +9.3%). After multivariable adjustment, these increases translated into higher odds of blood transfusions (odds ratio [OR]: 1.88, p = 0.008) and genitourinary complications (OR: 1.40, p = 0.027), as well as higher THCs (incidence rate ratio [IRR]: 1.08, p < 0.001). NID-T2DM patients (2,051 vs. 4,102 nondiabetic controls) exhibited smaller increases in blood transfusions (+2.5%) and THC (+5.3%), corresponding to OR 1.28 (p = 0.002) and IRR 1.05 (p < 0.001), respectively. CONCLUSION:Although ID-T2DM represents a relatively small subgroup, its rates increased over time. ID-T2DM was associated with higher rates of blood transfusions, genitourinary complications, and increased THC after NU. These findings suggest that ID-T2DM patients undergoing NU may represent a potential target population for perioperative optimization to reduce surgical morbidity and resource utilization.

Incidental prostate cancer (IPC) is not uncommon in patients undergoing surgery for benign prostate enlargement (BPE). However, the associated risk factors remain incompletely understood. This study aimed to evaluate potential clinical predictors of IPC. A systematic search of MEDLINE, Embase, and Web of Science was conducted in January 2025 to identify studies assessing risk factors for IPC. Pairwise meta-analyses were performed using a random-effects model, pooling adjusted odds ratios (ORs) and 95

PURPOSE:Although tobacco use and occupational exposures are established risk factors for urothelial cancer (UC), the influence of dietary factors remains uncertain. We conducted a systematic review to synthesize evidence from prospective cohort studies examining associations between dietary exposures and UC incidence. METHODS:A comprehensive literature search of MEDLINE, Embase, and Web of Science (May 2025) was performed to identify prospective studies evaluating dietary factors with UC incidence. The risk of bias was assessed using standard tools (CRD420251043101). RESULTS:From 6253 records screened, 32 prospective cohort studies were included, encompassing 2 277 677 participants. Investigated exposures included fluid intake (four studies, n = 562 038), coffee (four, n = 1 013 624), milk (three, n = 613 141), tea (three, n = 532 949), alcohol (three, n = 694 585), fruits (three, n = 597 753), vegetables (three, n = 555 685), protein (two, n = 469 339), fibre (two, n = 466 577), and cruciferous vegetables (two, n = 1 071 313). Only one study specifically assessed upper tract urothelial carcinoma (n = 80 388). Two studies suggested a borderline inverse association between high fluid intake and bladder cancer (BC) risk (upper 95% confidence interval >0.95), whereas two others found no such association. Three of four coffee studies reported no significant association after adjustment for smoking; one reported a modest increased risk. Fruit and vegetable intake showed modest inverse associations with BC risk in three studies. Most included studies were at moderate risk of bias, and residual confounding-particularly by smoking-remains a concern. CONCLUSION:Available evidence does not support a strong or consistent association between dietary factors and BC incidence. Although a healthy diet is beneficial for overall well-being, patients should be informed that dietary modifications alone are unlikely to meaningfully alter their BC risk.

Prostate-specific membrane antigen radioligand therapy (PSMA-RLT) has emerged as a promising treatment for metastatic castration-resistant prostate cancer (mCRPC). However, current patient selection methods – largely based on qualitative imaging criteria – may impede precision and efficacy of treatment. We aimed to evaluate the predictive value of quantitative imaging biomarkers derived from dual-tracer [68 Ga]Ga-PSMA-11 and [18F]F-FDG PET/CT, with a focus on concordant lesions. Thirty-seven mCRPC patients from two institutions underwent [68 Ga]Ga-PSMA-11 and [18F]F-FDG PET/CT prior to receiving at least two cycles of [177Lu]Lu-PSMA therapy. An automated pipeline enabled lesion segmentation, dual-tracer image fusion, and extraction of quantitative features from concordant (PSMA + /FDG +) and non-concordant lesions. A decision tree model was developed on the Vienna cohort (n = 24) and validated on an independent cohort from Augsburg (n = 13). SHAP analysis was used to identify key predictive features. The decision tree achieved 95.8

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.

To evaluate the oncological outcomes of second-look transurethral resection of bladder tumor (TURBT) in patients with a high grade (HG) Ta non-muscle invasive bladder cancer (NMIBC). We conducted a real-life multicenter study including all consecutive patients with HG Ta NMIBC, with or without second TURBT. Oncological outcomes included disease recurrence and progression. Multivariable Cox regression analyses were used to identify the independent predictors of bladder recurrence and progression. Of the 447 patients with HG Ta NMIBC, 240 (53.7

We aimed to analyze prognostic factors for overall survival (OS) and progression-free survival (PFS) in real-world patients treated with androgen deprivation therapy (ADT) combined with androgen receptor pathway inhibitors (ARPI) for metastatic hormone-sensitive prostate cancer (mHSPC). A systematic literature search was conducted in MEDLINE, Embase, and Web of Science in October 2025. Eligible studies examined prognostic factors for OS or PFS in patients with mHSPC receiving ARPI plus ADT using real-world data. To minimize the impact of confounding, we included only multivariable-adjusted estimates in the meta-analysis. Pooled hazard ratios (HRs) were calculated using a random-effects model and presented on forest plots. Risk of bias was evaluated using the QUIPS tool (CRD420251239659). Sixteen retrospective observational studies, comprising 3773 patients with mHSPC, were included. Poor PS (poor vs. good; HR 1.74, 95% CI 1.32-2.28, 5 studies, n = 1553), low haemoglobin (low vs normal; HR 1.75, 95% CI 1.03-2.97, 2 studies, n = 491), high LDH (high vs. normal; HR 1.8, 95% CI 1.14-2.85, 3 studies, n = 576), and ISUP GG5 (5 vs. ≤4: HR 2.21, 95% CI 1.53-3.21, 4 studies, n = 1221) were independently associated with worse OS. High EOD (≥1 or 0; HR 1.80, 95% CI 1.14-2.84, 2 studies, n = 330) was independently associated with worse PFS. The main bias was treatment selection bias inherent to retrospective studies. Limitations include residual confounding and heterogeneity in outcome definitions and prognostic factor measurements. Specific patient- and tumor-related factors are significantly associated with prognosis in patients with mHSPC treated with ARPI combination therapy. These factors may help identify patients who require closer monitoring and treatment adjustment (ie, escalation or de-escalation) as part of shared decision-making.