Isabel Galante Romo

Background: Oligometastatic prostate cancer (OMPC) comprises biologically and clinically distinct states with a limited number of detectable metastases. Improved systemic therapy and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) have intensified interest in treating the primary tumor. Methods: In this narrative review we searched PubMed/MEDLINE from inception to 1 July 2026, reviewed current guidelines, and searched ClinicalTrials.gov, the ISRCTN registry and the EU Clinical Trials Register for ongoing surgical studies, prioritizing randomized trials, prospective studies, PSMA PET-staged cohorts, systematic reviews, guidelines, and studies of perioperative, functional and patient-reported outcomes. Results: Registry and institutional data generated the hypothesis that cytoreductive prostatectomy improves outcomes but are vulnerable to selection bias; prospective and PSMA PET-staged cohorts established feasibility. The phase II trial by Dai and colleagues supported radical treatment of the primary tumor but combined surgery and radiotherapy. RAMPP provided the first prostatectomy-specific randomized signal, with lower 5-year cancer-specific mortality after radical prostatectomy plus best systemic therapy than after systemic therapy alone (13% versus 23%; hazard ratio 0.39, 95% confidence interval 0.16–0.98), but accrual ended early, clinical progression was similar, overall survival was not significantly improved, systemic therapy predated contemporary intensification, and major surgery-related complications occurred in 14%. A randomized phase II trial with a predominantly surgical local-therapy arm found no progression-free or overall survival benefit, so randomized evidence is mixed. All randomized evidence concerns radical prostatectomy or local treatment irrespective of surgical approach; no trial has tested a robot-specific oncologic effect. Guidelines recommend prostate radiotherapy for selected low-volume de novo metastatic disease and restrict surgery to clinical trials. Conclusions: Cytoreductive prostatectomy, delivered mostly as robot-assisted radical prostatectomy (RARP), is feasible and may improve local control while providing complete pathology, but it remains investigational; the robotic approach is the surgical platform, not a modality with distinct oncologic efficacy. Appropriate use requires expert-center surgery, modern staging, guideline-concordant systemic therapy, multidisciplinary selection, transparent counseling and, preferably, trial participation. Future trials must establish whether prostatectomy adds meaningful benefit beyond modern systemic therapy, prostate radiotherapy and metastasis-directed treatment, while measuring morbidity, continence and quality of life.

Prostate cancer (PCa) diagnosis has historically relied on the prostate-specific antigen (PSA) testing. Although the screening significantly reduces mortality rates, PSA has low specificity with risks of overdiagnosis and overtreatment. These limitations highlight the need for a more accurate diagnostic approach. Emerging technologies, such as artificial intelligence (AI), novel biomarkers, and advanced imaging techniques, offer promising avenues to enhance the accuracy and efficiency of PCa diagnosis and risk stratification. This narrative review comprehensively analyzed the current literature, focusing on new tools aiding PCa diagnosis (AI-driven image interpretation, radiomics, genomic classifiers, biomarkers, and multimodal data integration) with consideration for technical, regulatory, and ethical challenges related to clinical implementation of AI-based technologies. A literature search was performed using the PubMed and MEDLINE databases to identify relevant peer-reviewed articles published in English using the search terms “prostate cancer,” “artificial intelligence,” “machine learning,” “deep learning,” “MRI,” “histopathology,” and “diagnosis.” Articles were selected based on their relevance to AI-assisted diagnostic tools, clinical utility, and performance metrics. In addition, a separate section was developed initially to contextualize the limitations of current PSA-based screening approaches. The reviewed studies showed that AI had significant utility in prostate mpMRI interpretation (lesion detection; Gleason grading) with high accuracy and high reproducibility. For the pathologist, AI-driven algorithms improve the diagnostic accuracy of digital slide evaluation for histologic diagnosis of prostate cancer and automated Gleason score grading. Genomic tools such as the Oncotype DX test, combined with AI, could also allow for tailored and individualized risk prediction. Overall, multimodal models integrating clinical, imaging, and molecular data often outperform traditional PSA-based strategies and reduce unnecessary biopsies. Transition from PSA-centered toward AI-driven, biomarker-supported, and image-enhanced diagnosis marks a critical evolution in PCa diagnosis.

Prostate cancer is one of the most prevalent malignancies among men, with early and accurate diagnosis is essential for optimizing clinical outcomes. The Trinetra-Prostate^TM study is a prospective multicenter observational trial designed to evaluate the diagnostic performance of a novel blood-based test for detection of clinically significant prostate cancer. The test, developed by Datar Cancer Genetics, identifies circulating tumor cells (CTCs) in peripheral blood and is assessed against standard diagnostic modalities, including multiparametric magnetic resonance imaging and prostate biopsy. The primary objective of this study is to determine the sensitivity and specificity of the CTC assay for detecting cancer in men with elevated prostate-specific antigen levels and/or abnormal digital rectal examinations. Secondary objectives include assessing concordance with histopathological findings, potential to reduce unnecessary biopsies, and integration with existing diagnostic pathways. The study aims to enroll 250 men aged 45–75 years across multiple centers, applying the defined inclusion and exclusion criteria to ensure methodological rigor. The protocol includes detailed procedures for blood sampling, imaging, biopsy, and data analysis. Ethical approval was obtained and data protection measures are in place in accordance with international research standards. If validated, the CTC-based assay may offer a noninvasive and accurate alternative to current diagnostic approaches, improving patient stratification and reducing the burden of invasive procedures in prostate cancer diagnostics.

Background and Objectives: Prostate cancer (PCa) is a common disease, with a significant number of patients initially diagnosed with locoregional or distant metastases. This is why it is essential to have imaging tests with sufficient sensitivity and specificity. Given the recognized limitations of traditional imaging methods, PSMA-PET has emerged as a promising tool that may revolutionize the management of PCa. Material and Methods: We conducted a comprehensive literature review from August to October 2023 using databases and a review of key clinical guidelines on the topic, focusing on the sensitivity and specificity of PSMA-PET, its use in detecting lymph node metastases (LNm), its integration into nomograms, its comparison with conventional imaging and current guideline recommendations. Results: After considering the search strategy, as well as the inclusion and exclusion criteria, four articles and five guidelines were particularly considered in this review. Most of them suggest high specificity and limited sensitivity for ⁶⁸Ga-PSMA-PET, with increased detection rates compared to conventional imaging modalities, especially in high-risk PCa patients. However, it cannot replace an extended pelvic lymph node dissection (ePLND) at this time. Conclusions: Although the enhanced sensitivity and specificity of PSMA-PET relative to conventional imaging modalities offers a more precise evaluation of disease extent, prospective studies demonstrating a survival benefit are currently lacking; therefore, caution is advised when making therapeutic decisions.

Background and Objectives: Prostate cancer (PCa) is a common disease with a significant amount of patients first diagnose with locoregional or distant metastases. This is why it is essential to have imaging tests with sufficient sensitivity and specificity. Having traditional imaging methods with recognized limitations, PET-PSMA is born as a weapon to revolutionize the management of PCa. Material and Methods: We made a comprehensive literature review from August to October 2023 using databases and also a review of key clinical guidelines with the topic, focusing on sensitivity and specificity on PSMA-PET, its use in detecting lymph node metastases (LNm), integration into nomograms, comparison with conventional imaging and current guideline recommendations. Results: After considering search strategy, inclusion and exclusion criteria; 4 articles and 5 guidelines were particularly taken into account in this review. Most of them conclude with high specificity and limited sensitivity for 68Ga-PSMA-PET, increasing detection rates with respect to conventional imaging modalities, specially in high-risk PCa patients; but it cannot replace an extended pelvic lymph node dissection (ePLND) at this time. Conclusions: Although PSMA-PET enhanced sensitivity and specificity over conventional imaging modalities offer a more precise evaluation of disease extent; currently, prospective studies demonstrating a survival benefit are lacking, so caution is advised when making therapeutic decisions.

Localized high-risk (HR) prostate cancer (PCa) is a heterogeneous disease whose likelihood of a biochemical recurrence, metastatic progression and cancer-related mortality after initial treatment is higher when compared with patients with low (LR) or intermediate-risk (IR) disease. In the past, neoadjuvant therapy has shown an improvement in postoperative oncological variables but failed to demonstrate any survival advantages. With the promising results from novel treatments in metastatic and non-metastatic castration resistant PCa settings, new evidence has appeared in the literature in the neoadjuvant setting. Background/Objectives: To describe the current evidence for different neoadjuvant treatments before a radical prostatectomy in high-risk prostate cancer. Methods: We performed a comprehensive English literature search for original and review articles through January–August 2024, using Pubmed, Medline and ClinicalTrials.gov databases, as well as a comprehensive review of different international guidelines, searching the following terms: “neoadjuvant ADT prostate cancer”, “neoadjuvant ADT”, “prostate cancer surgery” and “neoadjuvant high-risk prostate cancer”. We included 61 papers for the final review. Results and Discussion: Neoadjuvant therapy is not recommended in daily practice by any international guideline. The National Comprehensive Cancer Network (NCCN) guidelines strongly discourage the use of ADT as a neoadjuvant therapy outside of clinical trials. ADT + ARTAs show promising data in phase-II trials, including favorable pCR, MRD, PSA relapse and salvage therapy rates. Clinical trials on chemotherapy, ¹⁷⁷Lu-PSMA, genomic-targeted therapies and markers of response leave room for further evidence acquisition due to their encouraging results. Conclusions: Currently, no phase III data supports systemic neoadjuvant therapy before RP. Phase II studies show promising data for ADT with second-generation agents, including favorable pCR, MRD, PSA relapse and salvage therapy rates.

Oligometastatic prostate cancer (OMPC) is an intermediate state between localised disease and widespread metastases that includes a spectrum of disease biology and clinical behaviours. This narrative review will cover the current OMPC scenario. We conducted comprehensive English language literature research for original and review articles using the Medline database and grey literature through December 2021. OMPC is a unique clinical state with inherently more indolent tumour biology susceptible to multidisciplinary treatment (MDT). With the development of new imaging techniques, patients with OMPC are likely to be identified at an earlier stage, and the paradigm for treatment is shifting towards a more aggressive approach to treating potentially curable patients. Multimodal management is necessary to improve patient outcomes due to the combination of available therapies, such as local therapy of primary tumour, metastasis directed therapy or systemic therapy, to reduce tumour load and prevent further disease progression. Additional prospective data are needed to select patients most likely to benefit from a given therapeutic approach.

OBJECTIVE: Nephron sparing surgery is the gold standard in cT1 renal tumor. In order to perform a safe and effective surgery is essential a good radiological study 3D printing is a new tool that allows the creation of virtual and physical trustworthy 3D reproduction of organs or anatomical structures of patients. METHOD: Non systematic review of PubMed database about the usefulness of 3D printing in renal surgery. RESULTS: 3D printing has a potential use in surgery planning, resident education and improving the communication and understanding of our patients. CONCLUSION: Today the number of publications and the use of these technique are still low. 3D printing is a useful tool in order to improve communication with patients and has a potential role in resident education. 3D printing technology could be useful in surgically complex cases since provides an exact model of the organ and the lesion before the intervention allowing a better surgery planning to the surgeon.

Transrectal ultrasound has been a diagnostic method for diagnosis of prostate cancer for more than 30 years. It increased its options after the incorporation of MRI in the 90s. The association of real-time ultrasound with anatomical and functional data of multiparametric magnetic resonance imaging (mpMRI) has changed the prostate cancer scenario and presumably will modify the therapeutic alternatives. OBJECTIVES AND METHODS: In the following non systematic review of the literature, we present the current situation of different types of fusion biopsy, the initial preclinical and clinical results as well as the data collected in the different meta-analyses. RESULTS: Although "in bore" biopsy has shown the best sensitivity, its economic and accessibility problems make it the least widespread. Cognitive biopsy is one of the most widespread despite being the one that provides the least objective results. Fusion biopsies with Software Platform are being developed as the most reproducible and affordable in our environment. The data in the literature is still insufficient to establish what is the best software. There are many points of controversy such as number of cores, approach, associated systematic biopsies and possible connotations when assessing the therapeutic attitude. CONCLUSION: None of the Software platforms have demonstrated superiority in the diagnosis of cancer, although their results are superior to those obtained through standard and cognitive biopsy and are more affordable than the "In bore" biopsy. It is necessary to standardize the publications to be able to compare results (classification of risk in resonance, number of cores, approach). The diagnosis of cancer guided by MRI should be a factor to consider in therapeutic decision nomograms. The next challenge is the incorporation of these systems in the protocols of active surveillance and Focal Therapy.

Introduction: Radical prostatectomy is a more skillful procedure in kidney graft recipients. Robotic surgery can provide a useful minimally invasive tool. Objectives: The study aims to evaluate the robotic-assisted laparoscopic prostatectomy (RALP) in kidney transplant recipients, describing intra/postoperative complications, renal and oncological outcomes. Methods: This is a retrospective study conducted in a single institution of 84 RALP. Four of them were kidney transplant recipients. Side of the renal graft, clinical stage, intra/postoperative events, operating time, creatinine levels before/after intervention and oncologic follow-up were recorded. A systematic review of the literature was performed. Results: Aged 61.25 ± 7.76 years, interval between renal transplantation and RALP: 10 ± 3.16 years. Mean prostate specific antigen: 7.1 ± 2.8 ng/ml, 2 patients were cT1c and 2 cT2a. Preoperative biopsies: Gleason score 3 + 3 in 3 patients, 3 + 4 in 1 patient. Charlson comorbidity index mean was 4.82 ± 0.82. No intra/postoperative events were reported. Mean operating time: 196 ± 20.8 min. Positive surgical margins: 2/4 patients. Pathological analysis: Gleason 3 + 4 in 2 patients and Gleason 3 + 3 in the others 2. A patient developed a bladder neck sclerosis. No differences between pre/postoperative creatinine. Three patients are free of biochemical recurrence and 1 patient required adjuvant radiotherapy. Conclusion: RALP in renal transplant recipients is a safe and feasible technique for localized prostate cancer. No difference in oncological outcomes and no impairments on renal function were found.