Daniele Raggi

Background Androgen deprivation therapy (ADT) + androgen receptor pathway inhibitor (ARPI) ± docetaxel represent the standard of care in patients with metastatic hormone-sensitive prostate cancer (mHSPC). However, some patients still have early progression (EP). EMETPRO is a multicentric, retrospective registry of patients with EP mHSPC. Methods Patients with EP mHSPC were defined as patients who had progression ≤6 months under ADT+docetaxel or ADT + ARPI or ≤9 months from ADT monotherapy start. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS). Results Data from eligible patients treated between 2005 and 2023 were retrospectively collected. 201 (50%) patients received ADT monotherapy, while 124 (31%) and 76 (19%) received ADT+docetaxel and ADT + ARPI, respectively. 365 (91%) patients underwent first-line treatment for mCRPC—majority of the ADT monotherapy received ARPI (38%) or docetaxel (34%), whereas 69% of the ADT+docetaxel received ARPI and 62% of the ADT + ARPI received docetaxel. In the group of patients treated with ADT the median PFS was 6.8 months while the median OS was 26.4. In the group of patients treated with combination therapy the median PFS and OS was 4.9 and 18.6 months for patients who received docetaxel and 5.6 and 19.5 months for patients who received ARPI, respectively. Neither the first-line mCRPC treatment nor the genetic profiles were associated with survival outcomes. Conclusions The results of our study suggest that patients with EP mHSPC are characterized by poor outcomes regardless of the type of treatment received at progression. The optimal first-line mCRPC therapy to use in these patients remains a crucial unmet clinical need.

The 7th Bench-to-Bedside Uro-Oncology: GU Cancers Triad Meeting, organized in conjunction with the 45th Annual Congress of the Société Internationale d’Urologie, was held on 31 October 2025, in Edinburgh, Scotland, and transmitted live on the SIU@U Congress app

Testicular cancer is the most common malignancy in males age 15-40 years and one of the most curable cancers, with a cumulative 10-year survival rate exceeding 90%. Management strategies depend on the histologic subtype, stage at diagnosis, sites of disease, tumor markers, and risk classification. Germ cell tumors, including seminomas and nonseminomas, constitute the majority of testicular cancers and require distinct therapeutic approaches. For localized disease, radical orchidectomy remains the cornerstone of treatment, followed by active surveillance, chemotherapy, or primary retroperitoneal lymph node dissection, depending on the histology and the risk of relapse. Seminomas are highly curable, with low-stage patients often managed through surveillance or postoperative single-agent carboplatin. By contrast, nonseminomas typically require adjuvant multiagent chemotherapy, such as bleomycin, etoposide, and cisplatin, particularly in higher-risk patients. For metastatic disease, chemotherapy remains the standard of care, achieving excellent cure rates even in patients with bulky tumors. Surgical resection of residual masses is especially critical in nonseminomatous germ cell tumors to remove viable cancer or teratoma components. The treatment of refractory or relapsed disease frequently involves second-line standard-dose or high-dose chemotherapy with autologous stem-cell transplantation, ideally performed in specialized high-volume centers. Before, during, and after treatment, multidisciplinary care is essential to addressing psychosocial challenges, optimizing fertility preservation, and enhancing quality of life. After curative treatments, long-term management involves regular follow-up to monitor for recurrence, late toxicities, and secondary malignancies, with survivorship programs playing a crucial role in meeting patients' ongoing needs. Advances in molecular diagnostics for early relapse detection and the introduction of targeted therapies continue to improve outcomes, particularly in resistant patients.

Representativeness of study participants

Supplementary Figure 1: Study flow-chart. Supplementary Figure 2: Kaplan-Meier curves of event-free survival according to tertile-split tumor mutational burden. Supplementary Figure 3. Kaplan-Meier curves of recurrence-free survival according to the molecular subtype. Supplementary Figure 4: PD-L1 staining values (CPS percentages) according to molecular subtypes, split by the three subtyping classifiers GSC/Decipher, Consensus classification, and TCGA.

Surgical safety outcomes in PURE-01 trial

Updated adverse events observed in ITT population