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 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.

INTRODUCTION:It is unknown whether marital status affects years of life lost (YLL) in metastatic prostate cancer (mPCa) according to race/ethnicity. METHODS:Within the SEER database (2004-2021), unmarried and married mPCa patients aged 40-80 years were identified. Age- and sex-matched controls were generated (Social Security Administration life tables and Monte Carlo simulation). YLL were quantified for unmarried and married mPCa patients and controls according to race/ethnicity. Subsequently, multivariable competing risks regression (CRR) models were fitted to assess cancer-specific mortality (CSM) and other-cause mortality (OCM). RESULTS:Among 34,202 mPCa patients, the distribution of unmarried patients according to race/ethnicity was as follows: 7267 (34.0%) in Caucasians; 3680 (57.0%) in African Americans; 1659 (37.0%) in Hispanics; and 478 (24.0%) in Asians/Pacific Islanders. YLL values in unmarried vs. married patients relative to age- and sex-matched population simulated controls, were as follows: 7.7 vs. 5.8 in Caucasians (Δ: 1.9), 9.6 vs. 7.9 in African Americans (Δ: 1.7), 7.9 vs. 6.7 in Hispanics (Δ: 1.2), and 6.3 vs. 4.7 in Asians/Pacific Islanders (Δ: 1.6). In multivariable CRR models, unmarried status independently predicted higher CSM (1.2-fold, p < 0.001) and OCM (1.2-fold, p < 0.001) in Caucasians, only higher CSM in African Americans (1.1-fold, p = 0.008) and in Asians/Pacific Islanders (1.2-fold, p = 0.02), but only higher OCM in Hispanics (1.5-fold, p < 0.001). CONCLUSION:Unmarried mPCa patients exhibited higher YLL values than their married counterparts, relative to age- and sex-matched population simulated controls, across all races/ethnicities. Interestingly, the YLL detriments originated from both CSM and OCM in Caucasians, only CSM in African Americans and Asians/Pacific Islanders, and only OCM in Hispanics.

Transperineal prostate biopsy (TPBx) is the gold standard for the diagnosis of prostate cancer, although it may transiently worsen lower urinary tract symptoms (LUTS). Preventive medical strategies for post-biopsy LUTS are lacking. Phytotherapeutic compounds have demonstrated benefits in LUTS management, but their effectiveness in mitigating urinary and sexual dysfunction following TPBx remains unexplored. This retrospective analysis included 623 patients who underwent TPBx (November 2023-July 2025) at San Raffaele Hospital, Milan, Italy. Following TPBx, patients either received Serenoa Repens, Lycopene and Selenium (Profluss®) with or without Epilobium-Palmitoylethanolamide-Calendula (Riflog CM®) (i.e. treatment group), or no post-biopsy treatment (control group). LUTS and erectile function (EF) were assessed using the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF) at baseline, 1 week, and 1 month after TPBx, respectively. Subgroup analyses were conducted according to baseline IPSS and IIEF severity, and logistic regression models evaluated the association between treatment exposure and LUTS worsening or EF recovery within each IPSS and IIEF category. Median PSA and prostate volume were comparable between treatment and control groups. The overall prostate cancer detection was 57

Management of rectourinary fistula (RUF) is challenging due to limited data and variability in presentation and treatment. We conducted a systematic review of radical prostatectomy (RP)-related RUF to assess clinical features, diagnostics, treatments, and outcomes, and to propose a structured algorithm to guide management. We conducted a systematic review in accordance with PRISMA guidelines to evaluate the clinical presentation, diagnostic strategies, management approaches, and outcomes of RUF following RP. A comprehensive search of PubMed, Embase, and Web of Science was performed from database inception to January 2025. Data were extracted on patient demographics, symptoms, diagnostic modalities, management strategies, surgical repair techniques and treatment outcomes. A total of 455 cases of RUF following RP were identified across 34 studies. The reported incidence of RUF ranged from <0.01

We report the results of a prospective trial aimed at describing the feasibility and accuracy of prostate-specific membrane antigen (PSMA) radio-guided surgery (RGS) during robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (ePLND) in patients with prostate cancer (PCa). This was a phase 2 study (NCT04832958) that enrolled 82 patients with localized PCa and a lymph node invasion (LNI) risk >5%. All patients underwent preoperative PSMA positron emission tomography (PET). [99mTc]Tc-PSMA-I&S was administered intravenously the day before surgery, followed by single-photon emission computed tomography/computed tomography. Side effects, perioperative outcomes, and the performance characteristics of PSMA-RGS for LNI detection were measured. A total of 62 patients completed all study procedures and were included in the final analyses. Median blood loss and length of stay were 50 ml and 4 d, respectively. No adverse events after tracer administration or intraoperative complications were recorded. Four patients experienced a Clavien-Dindo grade 3 complication within 30 d. Overall, PSMA-RGS identified two additional patients with high-risk PCa and pathologically node-positive (pN1) disease compared with preoperative PSMA PET, exhibiting a lower positive predictive value (PPV) and a similar negative predictive value (NPV) in the per-patient analysis (PPV: 50% vs 70%; NPV: 83% vs 83%). The PPV and NPV at per-region analysis in patients with molecular imaging node-positive (miN1) disease were higher for PSMA-RGS than for PSMA PET (PPV: 55% vs 42%; NPV: 85% vs 81%). In conclusion, PSMA-RGS identifies additional patients with pN1 disease missed by preoperative PSMA-PET among men with high-risk PCa, and extends the ePLND template in patients with miN1 disease, in whom PSMA PET underestimates the nodal burden. However, its NPV is suboptimal for avoiding ePLND in patients with PCa who have a LNI risk >5% and negative PSMA-RGS findings during RARP.