Molecular targeted therapies, omics, and AI based theranostics approaches for the treatment of prostate cancer.

From prostate specific antigen to genomic signatures: Advances in biomarkers for prostate cancer diagnosis and prognosis.

Watch-and-wait management (WW) of rectal cancer is accepted for select patients with a complete clinical response (cCR) to neoadjuvant therapy (NAT). The appropriateness of WW for cancers beyond the reach of digital rectal examination (DRE) and/or with a delayed cCR is unclear. In this retrospective multicenter study, tumor palpability and clinical response were determined after NAT. Local regrowth-free survival (LRFS), disease-free survival (DFS), rectal organ preservation (OP), and salvage surgery outcomes were assessed. Among 477 patients, 427 (90%) had palpable tumers, with initial cCR in 389 (91%) and delayed cCR in 38 (9%) patients, respectively, whereas 50 (10%) had nonpalpable tumors, with initial pCR in 38 (76%) and delayed pCR in 12 (24%) patients, respectively (p < 0.01). The 3-year LRFS rate was 81.4% (95% confidence interval [CI], 76.6-86.2%) for palpable tumors and 74.3% (95% CI, 61.0-88.6%) for nonpalpable tumors. The DFS rates were 80.8 % (95 % CI, 75.9-85.7%) and 74.3% (95% CI, 61.0-88.6%), respectively. The 3-year rectal OP rate was 82.7% (95% CI, 77.9-87.5%) and 76.0% (95%, CI, 62.9-89.1%), respectively, with no difference in the survival curves for these three outcomes. (all p > 0.05). The patients with initial cCR or delayed cCR also had no differences in LRFS, DFS, or OP, but the interval to each of these outcomes were decreased with delayed cCR (all p < 0.01). Watch-and-wait management of rectal tumors beyond the reach of DRE is appropriate, with oncologic and rectal organ preservation rates that do not differ from patients with palpable tumors. In comparison to cancers with initial cCR, cancers with delayed cCR have accelerated intervals to local regrowth, disease recurrence, and rectal organ loss.

Digital rectal examination: a skill neglected?

Digital rectoscopy may reduce demand on endoscopy units, particularly as part of a watch-and-wait (WAW) organ preservation strategy for rectal cancer. LumenEye is a digital rigid rectoscope offering high-resolution rectal visualisation, video streaming and biopsy capability without sedation. This study aimed to evaluate the safety and feasibility of LumenEye in a novel outpatient colorectal clinic primarily managing WAW patients. A single centre, retrospective analysis of all patients who underwent a LumenEye examination in this clinic between August 2023 and November 2024 was conducted. Demographic, procedural, referral and outcome data were collected from electronic health records. Descriptive statistics summarised findings, while chi-squared and logistic regression analyses identified factors associated with complications or early termination. A total of 327 procedures were performed; mean patient age was 67.6years. Most procedures (54.1%, n = 177) were for WAW patients, with 52.6% of referrals originating from the colorectal multidisciplinary team. LumenEye was generally well tolerated: pain requiring analgesia occurred in 5.8% (n = 19), early termination in 2.1% (n = 7) and minor bleeding in 1.2% (n = 4). No perforations or infections occurred. One local cancer recurrence (0.3%) was missed and subsequently identified on flexible sigmoidoscopy 3 months later. Pain and bleeding were significant predictors of early termination (p < 0.001). LumenEye is a safe and practical tool for outpatient rectal examination including patients with rectal cancer undergoing WAW organ preservation strategy. Its minimal support requirements and favourable safety profile suggest that it may be a valuable alternative to traditional endoscopy, particularly in settings where access is limited.

To evaluate accuracy and costeffectiveness of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) as single procedure in diagnosing and staging high grade prostate cancer (PCa). From June 2022 to December 2025, 330 men (median age: 65 years) underwent transperineal prostate biopsy for the suspicion of high grade PCa (PSA >20 ng/ml and/or suspicious digital rectal examination). All the patients underwent PSMA PET/CT targeted biopsy of intraprostatic lesions suspicious for PCa (Standard Uptake Value >8) combined with extended prostate biopsy. Median PSA was 30.5 ng/ml (range: 20-785 ng/ml) and 135/330 (41%) men had positive DRE; a csPCa was found in 325/330 (98.5%) patients and 297/325 (91.4%) had a Gleason score >8/ISUP Grade Group >4. Clinical staging by PSMA PET/CT demonstrated: 130 (40%) cT2PCa vs 195 (60%) cT3PCa cases; in detail, 95/325 (29.2%) had positive nodes, 60 (18.5%) bone metastases and 40 (12.3%) multiple metastases. The overall reimbursement for diagnosing PCa in the 330 patients submitted to prostate biopsy was 471,883,5 €.; using PSMA PET/CT without MRI the cost of this latter procedure could be spared for a total of 71,016 €. PSMA PET/CT as a single imaging procedure demonstrated an high accuracy in diagnosing and staging high grade PCa, moreover, improved cost-effectiveness and allowed to start quickly therapy.

A0406 Is the digital rectal exam (DRE) still relevant in the era of MRI imaging? Results of an international multi-institutional study

An electrochemical aptasensor based on synergistic effect of duplex-specific nuclease and nanoporous gold for ultrasensitive detection of prostate-specific antigen.

A0407 Selective digital rectal examination in the PSA–mpMRI era: diagnostic yield, rapid learning curve, and educational implications

Although prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is recommended for staging high risk prostate cancer (PCa), recently, it has demonstrated a good accuracy to guide targeted biopsy for the diagnosis of PCa. In this study we evaluated the cost-effectiveness of PSMA PET/CT as single procedure for diagnosis and staging high grade PCa. From June 2022 to June 2025 300 men (median age=65 years) underwent transperineal prostate biopsy at Cannizzaro Hospital (Catania, Italy) for suspicion of high grade PCa (PSA ≥20 ng/ml) and/or suspicious digital rectal examination (DRE). All the patients underwent PSMA PET/CT and intraprostatic lesions with a standard uptake value (SUVmax) ≥8 were submitted to targeted biopsies plus extended prostate biopsy. The overall cost of prostate biopsy was calculated using the Italian National Public Health System "Day Service" and "out of pocket" by market research to evaluate the cost of PSMA PET/CT, multiparametric magnetic resonance image (mpMRI), lung and abdominal CT and bone scan. Median PSA was 29.6 ng/ml (range=20-785 ng/ml) and 135/300 (45%) had positive DRE; a clinically significant PCa was found in 295/300 (98.3%) patients and 270/295 (91.5%) had a Gleason score ≥8/ISUP Grade Group ≥4. Clinical staging by PSMA PET/CT demonstrated: 125 (42.3%) cT2PCa vs. 170 (57.3%) cT3PCa cases; in detail, 86/295 (29.1%) had positive nodes, 42 (14.2%) bone metastases and 29 (9.8%) multiple metastases. The overall cost of the 300 prostate biopsies calculated using the Day Service model was 57,120€; conversely, the cost "out of pocket" of PSMA PET/CT would have been equal to 300,000/450,000€ and its exclusive use would have spared 103,000/300,000€ (25.5-40%) equal to the cost of mpMRI, bone scan, CT and staff trained to perform procedures reducing time of diagnosis and staging from a median of 90 to 45 days. PSMA PET/CT for diagnosis and staging as a single imaging procedure in men with suspicion high grade PCa, improved cost-effectiveness by reducing cost (25.5-40%), time to the diagnosis and staging, whilst allowing for timely therapy initiation in men with high risk of metastases.

This study examined the efficacy of a quality improvement initiative aimed at decreasing both operative vaginal deliveries and rectal lacerations, while also exploring the mechanisms contributing to rectal injuries and evaluating the effects of the standardized management of rectal lacerations during vaginal deliveries. We conducted a prospective cohort study of isolated rectal injuries during vaginal deliveries at a specialty hospital in northern China between 2023 and 2025. Patients were included if they fulfilled all three criteria: (i) isolated rectal injury during childbirth; (ii) gestational age 28 weeks or greater; and (iii) vaginal delivery. Prospectively collected data included demographic characteristics, labor and delivery details, and perioperative outcomes. Among 24 510 vaginal deliveries, 16 isolated rectal lacerations were identified, giving an incidence of 0.065% (1/1532). Fourteen cases (87.5%) occurred in nulliparous women. Five patients (31.3%) underwent forceps delivery, and six (37.5%) had mediolateral episiotomy. Most injuries (68.8%) occurred during the day shift. During the same period, the overall rates of operative vaginal delivery and mediolateral episiotomy were 8.8% and 11%, respectively. Following a revision of obstetric policies aimed at reducing operative vaginal deliveries, the incidence of isolated rectal laceration decreased significantly (0.077% vs. 0.039%, P < 0.01). All repairs were performed by the obstetric team without the involvement of other specialties. One patient developed an anovaginal fistula near the hymen. Isolated rectal laceration is a rare but potentially serious complication of vaginal delivery. Reducing operative vaginal deliveries might help lower its incidence, and careful rectal examination after vaginal birth is recommended to improve detection. Primary repair by an obstetric team is feasible and associated with generally good outcomes.

Prostate cancer is among the most diagnosed malignancies in men worldwide and a leading cause of cancer-related mortality. Early and accurate diagnosis is critical to improve patient outcomes and reduce the risks of overtreatment or missed detection. Conventional diagnostic approaches, including prostate-specific antigen (PSA) testing, digital rectal examination (DRE), and histopathological analysis, often suffer from limited sensitivity and specificity, leading to false positive or delayed diagnosis. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has recently emerged as an effective modality for prostate cancer detection, providing complementary anatomical and functional information. This study proposes a novel hybrid diagnostic framework that integrates Generalized Quantum Gamma Polynomial (GQGP) features, kinetic signal intensity features, and deep learning-based representations. GQGP features capture subtle intensity variations and quantum-inspired statistical characteristics, while kinetic features quantify contrast-enhancement dynamics to discriminate malignant from benign tissues. These handcrafted descriptors are fused with high-level features extracted using convolutional neural networks (CNNs) to construct a comprehensive feature representation. Experimental evaluation on publicly available prostate imaging datasets demonstrates that the proposed fusion framework significantly outperforms single-feature and traditional methods, achieving a classification accuracy of 97.32%. The results highlight the effectiveness of combining mathematical modeling, radiomics, and artificial intelligence for improved prostate cancer diagnosis.

Background: Fistula-in-ano (Bhagandara), chronic ano-rectal condition usually characterized by constant discharge, recurrence and challenges of sphincter injury following conventional surgical practice. Integrated approach of modern surgical intervention along with Ayurveda Kshara Sutra therapy provides a patient centric sphincter saving approach with better wound healing and less recurrence. Clinical presentation: 34-year-old male presented with chief complaints of pain and purulent discharge from perianal region from last 6 months. Per rectal examination shows 2 external openings at 10 o’clock position in perianal region and secondary subscrotal opening at 11 o’clock position. Internal opening at 12 o’clock position. MRI fistulogram showed low anal inter-sphincteric fistula. Intervention: Comprehensive integrated treatment of fistulectomy with primary threading for the main tract and fistulotomy for the secondary tract followed by weekly Yava Kshara Sutra application was carried out. Postoperative internal Ayurvedic medicines and local wound management were carried out and patient was regularly followed up. Outcomes: There was progressive reduction in main complaints of pain and discharge. Fistulous tract healed completely (secondary intention) in 33 days. Postoperative complications and recurrence did not reported during entire follow up period. There was no impairment of sphincter function. Finally, any adverse effects related to intervention were not seen. Conclusion: Low anal inter-sphincteric fistula-in-ano was successfully treated with integrated approach of fistulectomy, fistulotomy with Yava Kshara Sutra coupled with supportive Ayurvedic management. Therapy provided successful healing, preservation of sphincter function and no side effects with recurrence free recovery noted in subsequent follow up period. Further well-designed clinical studies are required to validate these outcomes and to establish standardized integrative treatment protocols for management of Bhagandara.

BackgroundSchistosomiasis remains an important public health challenge in Egypt despite decades of control programs. Intestinal involvement is relatively common but usually presents with diffuse mucosal disease, ulcerations, or multiple polyps. A solitary bleeding rectal polyp as the sole manifestation is exceedingly rare and can be mistaken for inflammatory bowel disease or colorectal neoplasia. This report aims to highlight this diagnostic challenge within the Egyptian context.Case PresentationA 28-year-old Egyptian male from a rural area presented with a 3-month history of intermittent lower abdominal pain and rectal bleeding. Physical examination was unremarkable except for mild lower abdominal tenderness and blood on digital rectal exam. Laboratory tests, including inflammatory markers, were normal; notably, stool microscopy was repeatedly negative for schistosome ova, despite the presence of RBCs and WBCs. Colonoscopy identified a solitary, pedunculated, and ulcerated rectal polyp (1.5 × 3.0 cm) at 20 cm from the anal verge, which was completely resected. Histopathological examination confirmed the diagnosis by demonstrating viable Schistosoma mansoni ova within eosinophilic granulomas and, critically, an adult worm residing in the submucosal vasculature, confirming active infection.The patient achieved full clinical recovery after praziquantel therapy, and this case underscores the importance of integrating parasitological, endoscopic, and histopathological perspectives when managing atypical colorectal lesions in endemic regions.ConclusionThis case is a striking example of intestinal schistosomiasis masquerading as a sporadic colorectal neoplasm. In endemic regions like Egypt, schistosomiasis must be considered in the differential diagnosis of solitary rectal polyps, even with negative stool examinations. The definitive diagnosis hinges on histopathological analysis, which is indispensable for guiding correct management and avoiding unnecessary interventions. This report reinforces the ongoing, evolving challenge of schistosomiasis in Egypt post-control programs.

Acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP) are poorly defined clinical entities, and diagnosis can be challenging. A clinical diagnosis of ABP can be made in the setting of an acute urinary tract infection (UTI) with systemic illness and evidence of prostatic involvement as defined by prostatic tenderness or fluctuance on digital rectal examination or prostatic abscess identified on imaging. Management includes a minimum of 2 weeks of antibiotics with surgical intervention reserved for refractory cases or prostatic abscess (depending on size). Chronic bacterial prostatitis should be suspected in a male patient with chronic urinary symptoms or recurrent UTIs. Diagnostic evaluation should include a 4- or 2-glass Meares-Stamey test, with a positive test confirming the diagnosis. Management includes 6 weeks of antibiotics. Surgery can be considered for particularly refractory cases. Future research into ABP and CBP can address questions about epidemiology, role of radiographic imaging, and duration of antimicrobial therapy.

A full-term pregnant HF crossbred cow was presented with the history of enlarged abdomen with distended udder for the past five days. Based on the clinical, rectal and ultrasonographic examination, the case was diagnosed as Hydramnion complicated with pre-pubic tendon rupture. By inducing parturition, a dead male cyclops foetus was delivered per vagi num. Animal made an uneventful recovery following treatment.

Objectives: Transperineal (TP) prostate biopsy is increasingly used because of its lower complication rates compared with the transrectal approach. However, prospective data regarding its effects on erectile and ejaculatory function remain limited. This study prospectively evaluated short-term sexual function outcomes after TP prostate biopsy in sexually active men. Methods: This single-center prospective observational cohort study included men undergoing TP prostate biopsy between 15 April 2025 and 1 September 2025. Indications for biopsy were prostate-specific antigen levels >4 ng/mL, abnormal digital rectal examination findings, or suspicious lesions (PI-RADS ≥ 3) on multiparametric prostate MRI. Sexual function was assessed at baseline and at 1 and 3 months after biopsy using the International Index of Erectile Function (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). Results: Overall, 249 sexually active men were analyzed. No significant changes in erectile or ejaculatory function were observed in the overall cohort at either follow-up point. In contrast, among 132 men diagnosed with prostate cancer, significant declines were observed in IIEF-5, PEDT, and MSHQ-EjD-SF scores at both 1 and 3 months compared to baseline (all p < 0.001). Conclusions: Transperineal prostate biopsy minimally affects sexual function in the general population. However, prostate cancer patients experience notable deterioration in erectile and ejaculatory outcomes, which may be a transient decline, and long-term follow-up is necessary for this subgroup.

Effects of rectal examination on intraocular pressure and behavioral responses in pregnant and non-pregnant mares.

ObjectiveThis study aimed to evaluate the diagnostic accuracy of artificial intelligence (AI)–enhanced micro‐ultrasound (micro‐US) for detecting clinically significant prostate cancer (csPCa) in men referred for prostate biopsy.Patients and MethodsWe retrospectively analysed 145 men undergoing micro‐US‐guided biopsy (79 with csPCa, 66 without). Deep features were extracted from 2D micro‐US slices using a self‐supervised convolutional autoencoder and classified with a random forest model under fivefold cross‐validation. Patients were considered csPCa‐positive if ≥8 consecutive slices were predicted positive. Diagnostic performance was assessed against biopsy pathology using receiver operating characteristic (ROC) analysis.ResultsThe AI–micro‐US model achieved an area under the ROC curve (AUC) of 0.871. At a fixed threshold, sensitivity was 92.5% and specificity 68.1%, outperforming a clinical model based on prostate‐specific antigen (PSA), digital rectal examination (DRE), age, and prostate volume (AUC 0.753; sensitivity 96.2%, specificity 27.3%).ConclusionAI‐enhanced micro‐US reduces false positives from conventional screening tools while preserving high sensitivity. It shows promise as a point‐of‐care alternative to MRI, integrating risk stratification and biopsy guidance into a single platform.

Prognostic value of rectal dilatation and histological features of the rectal wall in dogs with perineal hernia - a cohort and case-control study.