Chavdar Slavov

Prostate cancer is the most frequently diagnosed cancer in men, and systematic ultrasound-guided biopsy continues to be the standard method for diagnosis. Although the transrectal (TR) approach is commonly used, it is associated with a higher risk of infection and bleeding complications. The transperineal (TP) biopsy technique was introduced to lower these risks while preserving similar diagnostic accuracy. The purpose of this study was to evaluate and compare cancer detection rates, histopathological findings, and complication rates between transperineal (TP) and transrectal (TR) prostate biopsy methods. Four hundred and sixteen men referred for prostate biopsy at the University Multidisciplinary Hospital for Active Treatment “Tsaritsa Yoanna – ISUL” between January 2022 and December 2025 were included in the study. The patients' age ranged from 49 to 95 years (mean age 69.39 years, standard deviation – 8.365). The overall cancer detection rate was relatively similar – TR group (76.8%) vs. TP group (67.53%), while apparent differences are observed in ISUP grade. GG 1 is observed in 57% of patients in the TP group, while in the TR group, the percentage is significantly – 34%. Poorly differentiated prostate cancer (ISUP ≥ 4) is seen in 32% of patients who underwent TR biopsy, compared to 12% in the TP group.

Strictures of the male urethra are a relatively common disease with a serious impact on the quality of life in men. The lack of a universal operative technique gives rise to different opinions and recommendations when choosing the most appropriate treatment approach. The present study aimed to prospectively analyze the results of surgical treatment of male urethral strictures with a free oral mucosa graft in comparison with other operative techniques, and to compare the obtained results with the data from the other reference centres. For a period of 5 years – from January 2017 to March 2022, 84 patients with a urethral stricture (newly diagnosed and recurrent) were operated on and followed up at the Clinic of Urology with a specific activity in Andrology of “Tsaritsa Yoanna – ISUL” University Hospital. Patients were divided into 3 groups: patients after urethroplasty with a free oral mucosa graft; patients after urethroplasty using extragenital tissue graft and anastomotic urethroplasty; transurethral minimally invasive operative techniques. Patients from Group 1 and Group 2 had a mean recurrence-free period of 19.35 ± 8.24 months and 20.62 ± 6.5 months, respectively, which were statistically significantly longer compared to Group 3 (10.44 ± 9.84), p = 0.000. Lingual mucosa proves to be a highly efficient alternative material in urethroplasty.

We aim to investigate the role of the Herpesviridae family (HHV) in the onset and progression of prostate cancer (PCa) and to profile the local PCa immunological status. A total of 116 “tru-cut” biopsies (58 PCa and 58 benign prostatic hyperplasia [BPH]) and 49 formalin-fixed paraffin-embedded (FFPE) instances of PCa were analysed using real-time qPCR and histological examination. Infection with CMV, EBV, HHV6, and HHV7 was detected in 11.5% of the “tru-cut” biopsies (25.9% in BPH and 6.9% in the PCa group). In the formalin-fixed paraffin-embedded (FFPE) samples, infection was detected in 69.4% of the patients, with individual rates of EBV (47%), HHV6 (38%), HHV7 (41%), CMV (2.9%), HSV2 (2.9%), and VZV (5.8%). In the HHV-infected PCa cases, the histopathological landscape included intratumor lymphocyte infiltration with fibrosis and necrosis, periductal chronic inflammatory reaction and granulomatous lesions with foci of abscesses and necrosis, as well as inflammatory infiltration, chronic lymphadenitis, prostatic intraepithelial atrophy (PIA), and high-grade prostatic intraepithelial neoplasia (HGPIN). The majority of HHV-infected PCa patients were predominantly classified as grade G3/G4/G5 tumours, exhibiting perineural, perivascular, and lymphovascular invasion, seminal vesicle invasion, senile vesicle amyloidosis, and lymph node metastasis. Statistical analysis demonstrated a significant association between HHV infection and PCa (χ² ≈ 20.3, df = 1, p < 0.0001; Fisher’s exact test, p < 0.0001) with an odds ratio of 6.50 (95% CI: 2.80–15.12). These findings suggest that long-term HHV infection could contribute to a complicated and potentially altered immune PCa tumour environment due to inflammation. This may serve as a predictor of aggressive disease progression.

The search for dependable molecular biomarkers to enhance routine clinical practice is a compelling challenge across all oncology fields. Urothelial bladder carcinoma, known for its significant heterogeneity, presents difficulties in predicting responses to systemic therapies and outcomes post-radical cystectomy. Recent advancements in molecular cancer biology offer promising avenues to understand the disease’s biology and identify emerging predictive biomarkers. Stratifying patients based on their recurrence risk post-curative treatment or predicting the efficacy of conventional and targeted therapies could catalyze personalized treatment selection and disease surveillance. Despite progress, reliable molecular biomarkers to forecast responses to systemic agents, in neoadjuvant, adjuvant, or palliative treatment settings, are still lacking, underscoring an urgent unmet need. This review aims to delve into the utilization of current and emerging molecular signatures across various stages of urothelial bladder carcinoma to predict responses to systemic therapy.

After recent approvals, poly-adenosine diphosphate [ADP]-ribose polymerase inhibitors (PARPis) have emerged as a frontline treatment for metastatic castration-resistant prostate cancer (mCRPC). Unlike their restricted use in breast or ovarian cancers, where approval is limited to those with BRCA1/2 alterations, PARPis in mCRPC are applied across a broader spectrum of genetic aberrations. Key findings from the phase III PROPEL trial suggest that PARPis’ accessibility may broaden, even without mandatory testing. An increasing body of evidence underscores the importance of distinct alterations in homologous recombination repair (HRR) genes, revealing unique sensitivities to PARPis. Nonetheless, despite the initial effectiveness of PARPis in treating BRCA-mutated tumors, resistance to therapy is frequently encountered. This review aims to discuss patient stratification based on biomarkers and genetic signatures, offering insights into the nuances of first-line PARPis’ efficacy in the intricate landscape of mCRPC.

Over the last 20 years, many Generalized Net (GN) models of the ways of functioning of the different systems and organs in the human body and models related to the description of biomedical processes in living organisms have been constructed. In this paper, a GN model of the prostate gland’s functioning was developed, as a continuation of the previous research. The model provides the possibility to trace the logical relations of the interactions of the prostate gland and various individual organs in the human body. The model shows the possibility for the existence of currently unknown feedback loops.

Background: Prostate-specific-antigen (PSA) screening resulted in reduced prostate cancer (PCa) mortality in a large clinical trial, but due to a high false-positive rate, among other concerns, many guidelines do not endorse universal screening and instead recommend an individualized decision based on each patient’s risk. Genetic risk may provide key information to guide the decisions of whether and at what age to screen an individual man for PCa. Methods: Genotype, PCa status, and age from 34,444 men of European ancestry from the PRACTICAL consortium database were analyzed to select single-nucleotide polymorphisms (SNPs) associated with prostate cancer diagnosis. These SNPs were then incorporated into a survival analysis to estimate their effects on age at PCa diagnosis. The resulting polygenic hazard score (PHS) is an assessment of individual genetic risk. The final model was validated in an independent dataset comprised of 6,417 men with screening PSA and genotype data. PHS was calculated for these men to test for prediction of PCa-free survival. PHS was also combined with age-specific PCa incidence data from the U.S. population to generate a PCa-Risk (PCaR) age that relates a given man’s risk to that of the population average. PHS and PCaR age were evaluated for prediction of positive predictive value (PPV) of PSA screening. Findings: PHS calculated from 54 SNPs was very highly predictive of age at PCa diagnosis for men in the validation set ( p =10 ⁻⁵³ ). PPV of PSA screening varied from 0.18 to 0.52 for men with low and high genetic risk, respectively. PHS modulates PCa-free survival curves by an estimated 20 years between men in the 1 ^st or 99 ^th percentiles of genetic risk. Interpretation: Polygenic hazard scores give personalized genetic risk estimates and can inform the decisions of whether and at what age to screen a man for PCa. Funding: Department of Defense #W81XWH-13-1-0391