Pathologic Upgrading in Biopsy Grade Group 1, PI-RADS ≥ 3 Prostate Cancer: Factors Associated With Clinically Significant Disease on Radical Prostatectomy.

Urinary incontinence (UI) remains a common complication after radical prostatectomy, even with advancements such as robotic-assisted radical prostatectomy (RARP). Preoperative membranous urethral length (MUL) has been suggested as a predictor of early continence recovery, but its role in Retzius Sparing RARP (RSRARP) remains unclear. This study evaluated the association between preoperative MUL and early postoperative UI in patients undergoing RSRARP. We retrospectively analyzed 157 patients who underwent RSRARP between March 2024 and February 2025 at a high-volume center. All had preoperative multiparametric MRI (mpMRI) with MUL measurements and documented continence outcomes at 6 weeks and 3 months. Continence was defined by pad use: pad-free, mild incontinence (1 pad/day), or moderate-to-severe ( ≥ 2 pads/day). Correlation testing and ordinal logistic regression assessed MUL's predictive value. Secondary analysis included age, BMI, prostate volume, and bladder neck preservation. At 3 months, 97% of patients were pad-free and 3% used one pad. Mean MUL was 12.6 mm (SD 2.7). No significant correlation existed between MUL and continence (Spearman's ρ = -0.046, p = 0.570). Regression confirmed MUL was not predictive (p = 0.745). Bladder neck preservation strongly correlated with pad-free continence, while larger prostate size trended toward higher UI but without significance. Preoperative MUL was not identified as a statistically significant predictor of early continence after RSRARP. Bladder neck preservation was associated with favorable continence outcomes; however, given the small number of incontinence events, these findings should be interpreted cautiously. Overall, the high continence rates observed highlight the potential benefit of the Retzius-sparing approach.

Approximately 20-50% of patients develop biochemical recurrence (BCR) of prostate cancer within 10 years following radical prostatectomy (RP). The accurate identification of recurrent disease is crucial for guiding salvage treatment decisions. While multiparametric MRI (mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) are both utilized for detecting local recurrence, their combined diagnostic benefits remain unclear. This study seeks to evaluate the diagnostic performance of both modalities alone and in conjunction for detecting local recurrence following RP in patients with BCR. A retrospective single-institution analysis included 37 post-RP patients with BCR who received mpMRI and PSMA PET/CT. Five board-certified radiologists reviewed images in three phases: mpMRI only, PSMA PET/CT only, and both modalities combined. Multidisciplinary tumor board consensus served as the reference standard. Diagnostic performance, inter-reader agreement, and radiologist confidence with each modality was examined. MpMRI outperformed PSMA PET/CT, yielding a higher sensitivity (73.0% vs. 65.2%) and specificity (77.1% vs. 75.7%). Interpretation of mpMRI and PSMA PET/CT together achieved the highest diagnostic accuracy (77.8%), representing a statistically-significant increase over PSMA PET/CT (p = 0.026) but a non-statistically-significant increase over mpMRI (p = 0.441). Combined imaging also resulted in greater specificity (90.0%) and inter-rater reliability (κ = 0.622). However, in some cases performance decreased with both modalities due to interpretive pitfalls. While mpMRI remains the preferred imaging modality for post-RP local recurrence surveillance, the integration of PSMA PET/CT may lead to improved specificity and inter-rater reliability. However, radiologists must understand each modality's limitations to avoid interpretive pitfalls.

To evaluate the correlation between the pad-per-day (PPD) count and the 24-h pad test (24 h-PT) during the first postoperative year after radical prostatectomy (RP), and to determine the clinical utility of the PPD count for quantitative urinary incontinence (UI) assessment. We retrospectively analysed a prospectively maintained database of 2040 men who underwent RP between 2001 and 2025 at a tertiary referral centre. A total of 8787 paired measurements of PPD count and 24 h-PT were analysed. Urinary leakage was assessed at standardised timepoints (1 week, 6 weeks, 3, 6, and 12 months) using count of PPD and nurse-supervised 24 h-PT. UI severity was classified as mild (<100 g), moderate (100-400 g), or severe (>400 g). Correlations were calculated using Spearman's ρ. The correlation between the PPD count and 24 h-PT was strong across all timepoints and increased over the postoperative year, from ρ = 0.77 at 1 week to 0.99 at 12 months. The overall correlation for all paired measurements was ρ = 0.94 (95% confidence interval 0.93-0.94). The median (interquartile range) 24 h-PT values rose consistently with increasing PPD count categories: from 15 (7-38) g for 1 pad/day to 781 (478-1200) g for ≥5 pads/day. At 12 months, 94% of men using one pad had urine loss <100 g, whereas 85% of those using ≥5 pads/day exceeded 400 g. Intermediate categories (2-4 pads/day) showed wide variability, limiting their discriminative value. The PPD count shows a strong correlation with 24 h-PT throughout the first postoperative year after RP. Use of 0-1 pad/day effectively excluded moderate-to-severe UI, whereas ≥5 pads/day reliably identified severe UI. The PPD count is a practical follow-up tool, while 24 h-PT remains necessary for patients using 2-4 pads/day.

Prostate MRI quality assessment using PI-QUAL version 2: Comparative analysis between 1.5T and 3T scanners and its association with T-staging agreement.

This study aimed to evaluate the feasibility, safety and effectiveness of the newly developed KangDuo-Surgical-Robot-2000 (KD-SR-2000) in robotic assisted radical prostatectomy (RARP). This prospective, multicenter, single-arm trial was conducted from October 2023 to April 2024. Thirty patients with clinical T1-3 prostate cancer underwent RARP using the KD-SR-2000. The study was approved by the institutional review boards. Perioperative results, early oncologic outcomes, urinary continence, and ergonomic workload (NASA-TLX) were assessed. All surgeries were performed successfully without any conversion. No severe perioperative complications (Clavien-Dindo grade≥III) or equipment-related adverse events occurred. Positive surgical margin was observed in five patients (16.7%). One (3.3%) patient experienced PSA persistence at 6weeks. Urinary continence rate was 66.7% (20/30) at 4weeks after catheter removal. The median NASA-TLX score was 22.5 (IQR 6-35.25). This study demonstrates the preliminary feasibility, safety and effectiveness of the KD-SR-2000 robotic system in RARP. www.chictr.org.cn: ChiCTR2300076954.

To develop a machine learning (ML) model predicting positive surgical margins (PSM) after robot-assisted radical prostatectomy (RARP). We conducted a single-centre retrospective analysis of 301 patients with RARP (211 for training and 90 for validation). Twenty-four features were reduced to five using the Boruta algorithm. Seven ML models were developed and evaluated, and the optimal model was interpreted using SHAP. PSM incidence was 42.0%. The artificial neural network (ANN) performed best (AUC 0.808, accuracy 0.811, sensitivity 0.789, F1 0.779). SHAP identified clinical T stage, creatinine, high-risk status, and positive biopsy percentage as risk factors, while neoadjuvant therapy was protective. The ANN model demonstrates potential in predicting PSM following RARP. Currently, it serves as an exploratory predictive tool for risk stratification, requiring further external validation prior to direct clinical application.

Single Port Extraperitoneal Versus Multiport Transperitoneal Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Post-prostatectomy incontinence (PPI) is a well-recognized complication of transurethral or radical prostatectomy. Platelet-rich plasma (PRP) has been used in regenerative medicine. This study aimed to evaluate the therapeutic efficacy of repeated PRP injections into the urethral sphincter for PPI. Totally 71 patients with PPI refractory to conservative treatments. Each patient received four monthly PRP injections into the urethral sphincter. The primary endpoint was the Global Response Assessment (GRA) score for urinary incontinence improvement. Secondary endpoints included changes in the visual analog scale (VAS) for urinary incontinence, the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7), daily pad usage, and urodynamic parameters three months after the fourth PRP injection. The mean age was 71.0 ± 7.2years, with a mean PPI duration of 35.5 ± 36.8months. After PRP injections, the mean GRA score was 1.30 ± 1.23. A GRA score of 2 or 3 was reported in 29 (40.8%) patients, and a GRA score of = 1 was reported in 27 (38.0%), and 15 (21.1%) showed no improvement or reported worsening. Significant improvements were observed in the VAS score, UDI-6 score, and abdominal leak point pressure (ALPP). The increase in ALPP was significantly greater in the successful group than in the failed group (49.3 ± 78.3 vs. 4.9 ± 52.4 cmH2O, p = 0.028). Baseline cystometric bladder capacity (CBC) was identified as a significant predictor of a successful outcome (p = 0.047). Repeated urethral sphincter PRP injections can reduce the severity of PPI and increase ALPP in 40.8% patients with PPI. The results of this study support PRP as an exceptional therapy with low success but few complications.

Social support, specifically marital status, has been shown as a significant prognostic factor for survival of multiple malignancies, including prostate cancer. However, this has not been investigated in an equal access Veterans Affairs (VA) cohort where other support systems exist that may minimize the potential benefit of social support from a partner. We retrospectively reviewed data from 9,931 patients undergoing primary radical prostatectomy (RP) in the VA from 1988-2020 across 9 VA centers. Univariable and multivariable Cox proportional hazards models were used to test the association between marital status and biochemical recurrence (BCR), metastasis, castration-resistant PC (CRPC) and prostate cancer specific mortality (PCSM). 8,285 patients met the inclusion criteria: 54% were married, 30% were divorced/separated, 9% were single/never married, and 6% were widowed at the time of RP. Single/never married men were younger (median 61 vs 62-65years), had surgery more recently (median 2009 vs 2003-2008), had higher PSA (median 6.9ng/mL vs 6.4-6.8ng/mL), and had lower BMI (median 27 vs 28) compared to other groups (all p < 0.05). The median time to BCR was significantly shorter for divorced/separated men (188.2months) and single/never married men (154.8months) compared to married men (243.0months). Consistent with this finding, compared to married men, divorced/separated men had higher risk of BCR (HR = 1.12; 95% CI 1.03-1.21), as did single/never married men (HR = 1.13; 95% CI 1.00-1.28). However, these associations were insignificant in multivariable analyses (all p > 0.05). Among men with localized prostate cancer undergoing RP within the VA, we found no association between marital status-defined as a demographic indicator of self-reported relationship category-and oncologic outcomes. Whether marital satisfaction or perceived partner support, which were not assessed in this study, influence post-RP outcomes remains to be investigated.

The Diagnostic Role of Prostate-specific Membrane Antigen Positron Emission Tomography for Patients with Rising PSA After Radical Prostatectomy and Postoperative Radiotherapy: A Systematic Review and Meta-analysis.

To create a risk stratification model for biochemical recurrence by examining the relationship between the positive surgical margin status and biochemical recurrence in patients with prostate cancer after radical prostatectomy. This retrospective study included 3,010 patients who received radical prostatectomy. We analyzed the effect of postoperative pathological results using the Kaplan-Meier method and Cox model regression analysis in patients with no positive lymph node. A risk stratification model incorporating the total positive surgical margin length was constructed based on factors predicting biochemical recurrence. Among the total 1,865 patients, 346 (19%) experienced biochemical recurrence after radical prostatectomy and 377 (20%) had a positive surgical margin. The median positive surgical margin count was 1, and the median total positive surgical margin length measured 1.0 mm. The multivariable regression analysis revealed significant associations between biochemical recurrence and the following factors: preoperative prostate-specific antigen level > 20 ng/mL (p < 0.001), pathological Gleason grade (p < 0.001), extraprostatic extension (p < 0.001), seminal vesicle invasion (p < 0.001), lymphovascular invasion (p = 0.010), and total positive surgical margin length of ≥ 1 mm (p < 0.001). Patients were classified into good-, intermediate-, and poor-risk groups corresponding to the presence of 0, 1, or ≥ 2 factors, respectively. The 5-year survival rates without biochemical recurrence were 93%, 81%, and 47%, respectively. Our risk stratification model for biochemical recurrence after radical prostatectomy incorporates preoperative prostate-specific antigen level and pathological results, thereby aiding in patient counseling and the selection of appropriate adjunctive therapy after radical prostatectomy.

Salvage radiotherapy (SRT) is the standard of care for patients with biochemical recurrence (BCR) after radical prostatectomy (RP). Several randomized trials have evaluated the addition of hormonal therapy (HT), including androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs), to SRT; however, differences in patient selection, treatment duration, and endpoints have led to inconsistent results. We performed an updated systematic review and meta-analysis to clarify the clinical benefit of adding HT to SRT in this setting. A comprehensive literature search of PubMed/MEDLINE, EMBASE, the Cochrane Library, ClinicalTrials.gov, and ASCO and ESMO meeting abstracts was conducted through April 2025. Randomized phase II-III trials enrolling patients with confirmed BCR after RP and comparing SRT with or without HT were included. Five trials (GETUG-AFU 16, RTOG 9601, RTOG 0534/SPPORT, RADICALS-HD, and SALV-ENZA), comprising 4536 patients, met the eligibility criteria. Hazard ratios (HRs) and 95% confidence intervals (CIs) for metastasis-free survival (MFS), progression-free survival (PFS), biochemical progression-free survival (bPFS), and overall survival (OS) were pooled using fixed- or random-effects models according to heterogeneity. Analyses were stratified by HT duration (short-term vs. long-term), and subgroup analyses were performed based on pathological features. Short-term HT combined with SRT significantly improved bPFS (HR = 0.57; 95% CI: 0.46-0.71, p < 0.00001), PFS (HR = 0.58; 95% CI: 0.49-0.69; p < 0.00001), and MFS (HR = 0.82; 95% CI: 0.69-0.96; p = 0.02). Long-term HT was also associated with improved MFS (HR = 0.76; 95% CI: 0.61-0.94; p = 0.01). No statistically significant OS benefit was observed with either short-term or long-term HT. Subgroup analyses showed a significant MFS benefit in patients with positive surgical margins (HR = 0.68; 95% CI: 0.47-0.98; p = 0.04), whereas no clear benefit was detected in patients with Gleason score ≥8 or negative margins. The addition of HT to SRT improves disease control outcomes in patients with BCR after RP, particularly in those with positive surgical margins, although no overall survival benefit was demonstrated. These findings support a tailored approach to treatment intensification in the salvage setting.

MRI-based atlas for prostate bed recurrence after radical prostatectomy: consistency of CTV delineation with 7 contouring guidelines.

Feasibility and safety of Toumai® robot-assisted radical prostatectomy: initial experience from a European referral centre.

The EDGE single-port endoscopic surgical robot (SP1000), specifically designed for urological, gynecological, thoracic and general surgical procedures, has recently been applied in various operations. However, there is currently a lack of evidence comparing its performance with the Da Vinci Xi robot system. This study aims to compare the technique and perioperative outcomes of radical prostatectomy (RP) performed with EDGE SP1000 versus the Da Vinci Xi robot system. Data were collected from radical prostatectomy cases performed at Anhui Medical University from March 2025 to December 2025. 101 patients underwent radical prostatectomy using EDGE SP1000 and 102 patients using Da Vinci Xi were operated on using the Da Vinci Xi system. A 1:1 propensity score matching method was applied to compare the two groups both before and after matching based on age, body mass index, prostate size, prostate specific antigen (PSA) level, and Gleason score. We primarily evaluated the surgical efficacy of the two robotic systems by comparing perioperative clinical data. In the matched surgery groups (EDGE SP1000 vs. Da Vinci Xi), there were no significant differences in age (68.6 years vs. 69.3 years; p = 0.59), PSA (10.3 ng/ml vs. 10.1 ng/ml; p = 0.93), Gleason score (7 vs. 7; p = 0.41) and prostate volume (38.0 cm3 vs. 37.4 cm3; p = 0.81). All procedures were completed successfully without any conversion to open surgery. There was no significant difference in the total operative time between the two groups (136.6 vs. 129.0min; p = 0.14). No major intra or postoperative complications were observed in either group. Positive surgical margin rates were no significant (36% vs. 41%; p = 0.41). Despite the design variations between the two robotic systems, there were no significant differences in the final surgical outcomes. The EDGE SP1000 system serves as a viable option for radical prostatectomy.

To describe the safety and effectiveness of the Hugo™ robot-assisted surgery (RAS) system (Medtronic, Minneapolis, MN, USA) when used for three urological procedures. The Expand URO (ClinicalTrials.gov identifier: NCT05696444) was the first investigational study for the Hugo RAS system based in the United States. It was a prospective, single-arm, multicentre clinical trial conducted at six medical centres. Patients indicated for radical prostatectomy (RP), radical cystectomy (RC), or partial or radical nephrectomy were enrolled from December 2022 to September 2024. The primary effectiveness endpoint was surgical success (freedom from conversion) and was hypothesised to be >85% for the three procedures combined. The primary safety endpoint was the 30-day major complication (Clavien-Dindo Grade ≥III) rate, hypothesised to be below 20%, 45%, and 20% for RP, RC, and nephrectomy, respectively. Secondary endpoints included operative characteristics and postoperative outcomes through 30 days. A total of 144 patients were enrolled, and 137 underwent a procedure (55 RPs, 29 RCs, 53 nephrectomies). The conversion rate was low (1.5%) resulting in a surgical success rate of 98.5% across all procedures. The major complication rates for RP, RC, and nephrectomy were 3.7%, 17.9%, and 1.9%, respectively. Of the 137 treated patients, 124 were oncological patients. The overall positive surgical margin rates were 21.8%, 7.1%, and 2.4% in RP, RC, and nephrectomy, respectively. The Expand URO study achieved its primary endpoints for safety and effectiveness. Operative characteristics and short-term postoperative outcomes obtained with the Hugo RAS system were consistent with those in the literature.

Extraprostatic extension (EPE) significantly impacts surgical planning for prostate cancer (PCa) patients, influencing nerve-sparing surgery and neoadjuvant therapy decisions. However, Likert-scale-based radiological (r)EPE assessment lacks sufficient diagnostic accuracy for reliable clinical decision-making. Therefore, the aim was to evaluate rEPE scoring alongside clinical parameters to develop a clinically feasible decision tree for preoperative risk stratification. This retrospective single-center study included 429 consecutive PCa patients undergoing radical prostatectomy between January 2012 and October 2018. All patients underwent multiparametric MRI with PI-RADS scoring and rEPE grading (grades 0-3). Clinical parameters included PSA density (PSAD) and ISUP grade group (GG) at biopsy. Univariate and multivariate logistic regression identified predictors of EPE. A clinical decision tree was developed using binary classification to stratify patients into risk groups. EPE was confirmed in 145 patients (33.8%). Multivariate analysis identified rEPE grade (OR 2.64, p < 0.001) and GG at biopsy (OR 1.41, p < 0.001) as independent predictors. The decision tree assigned 48% of patients to the high-risk (rEPE grade 3: 89% EPE risk) and low-risk group (rEPE < 3 + PSAD < 0.2 ng/mL² + GG < 4: 13% EPE risk), while 52% showed intermediate risk (28-45% EPE risk). The developed decision tree combining MRI-derived rEPE grading, PSAD, and biopsy GG enables reliable identification of patients at high and low risk for EPE. This tool supports informed decision-making regarding nerve-sparing surgery and neoadjuvant therapy, potentially contributing to personalized treatment planning. Decision tree combining routine MRI-based and clinical markers reliably stratifies prostate cancer patients into high-risk and low-risk groups for EPE, supporting personalized surgical planning. EPE affects surgical planning decisions in prostate cancer patients. Combining EPE grade at MRI, PSAD, and biopsy grade improves risk stratification. The developed decision tree reliably stratified every second patient into distinct EPE-risk groups, potentially improving personalized surgical planning.

Presenting postoperative mortality as percentages and natural frequencies (1-in-N) in major urologic cancer surgeries.

To develop and validate a preoperative mpMRI-based radiomics-clinical nomogram integrating dual-region radiomics features from intratumoral lesions and periprostatic adipose tissue (PPAT) with clinical factors for predicting positive surgical margins (PSM) after radical prostatectomy (RP) in non-metastatic prostate cancer (PCa). This two-center retrospective study included 423 patients (age, 69.78 ± 6.30 years) with non-metastatic PCa who underwent mpMRI followed by RP between January 2019 and December 2024. Intratumoral and PPAT ROIs were manually segmented on T2-weighted images and apparent diffusion coefficient (ADC) maps. After reproducibility filtering, high-correlation removal, and least absolute shrinkage and selection operator (LASSO) regression, three radiomics signatures were constructed. Independent predictors were identified by multivariable logistic regression and integrated into a radiomics-clinical nomogram. Performance was assessed using ROC/AUC, FDR-adjusted DeLong tests, calibration curves, Hosmer-Lemeshow tests, decision curve analysis (DCA), and 1,000-iteration bootstrap validation; subgroup ROC analyses were also performed. Twelve intratumoral and nine PPAT radiomics features were selected, and the combined tumor-PPAT radiomics signature (TPR signature) demonstrated superior predictive performance compared with either single-ROI signature across cohorts (training AUC = 0.824; 95% CI, 0.776-0.865; validation AUC = 0.816; 95% CI, 0.737-0.935). Independent predictors included initial PSA, biopsy ISUP grade group, clinical T stage, and the TPR signature. The radiomics-clinical nomogram showed strong discrimination (AUC = 0.908 and 0.885 in the training and validation cohorts, respectively), with good calibration (Hosmer-Lemeshow p = 0.848 and 0.782) and favorable decision-curve performance across threshold probabilities of 0.1-1.0. Bootstrap resampling confirmed model stability, yielding mean AUCs of 0.908 (95% CI, 0.871-0.939) in the training cohort and 0.888 (95% CI, 0.827-0.936) in the validation cohort. A dual-ROI mpMRI radiomics-clinical nomogram integrating intratumoral and PPAT phenotypes enables accurate preoperative prediction of PSM after RP and may aid individualized surgical planning.