Andrey B. Chaprak

Aim. To assess the frequency, risk factors, and prognostic value of persistent prostate-specific antigen (PSA) levels 3 months after radical prostatectomy (RP), and to evaluate the role of positron emission tomography combined with computed tomography, with prostate-specific membrane antigen (PSMA-PET/CT) and early treatment strategies in patients with PSA persistence. Materials and methods. A retrospective study of 837 patients with prostate cancer (PCa) who underwent RP between 2019 and 2024. PSA persistence was defined as a level ≥0.1 ng/mL at 3 months postoperatively. Clinicopathological features, biochemical and metastatic outcomes were analyzed. Predictive models using logistic regression and machine learning algorithms (MLP, Random Forest) were developed. ROC curve analysis (AUC) and Kaplan–Meier survival curves were used to assess predictive accuracy and metastasis-free survival. Results. PSA persistence was observed in 285 patients (34.0 %). It was significantly associated with high-grade disease (ISUP ≥3 (ISUP – International Society of Urological Pathology); hazard ratio 2.10; p = 0.001) and advanced pathological stage pT3–T4 (p = 0.039), but not with positive surgical margins (p = 0.92). Predictive models showed moderate accuracy (AUC 0.59–0.60), with preoperative PSA being the most important feature (40 % contribution in Random Forest). Three-year metastasis-free survival was 98.5 % in the persistence group vs 99.7 % in the non-persistence group (p 0.3). PSMA PET/CT identified residual disease in 68 % of persistent PSA cases and influenced treatment decisions. Conclusion. Persistent PSA at 3 months post-RP is a common and clinically relevant marker, strongly associated with aggressive disease. Early detection using PSMA PET/CT and risk-adapted salvage treatment improve disease control and metastasis-free outcomes.

An option of hydraulic tissue preparation or hydrodissection with or without ICG during laparoscopic nerve-sparing radical prostatectomy is described here in “Tips & Tricks” manner. Author's “Lifehack” to make this manipulation easier is also presented (video is available at https://youtu.be/DZv7GPiwbi0).

Introduction . Prostate cancer remains one of the leading oncological diseases among men, necessitating precise diagnostic strategies. Contemporary approaches, including multiparametric MRI (mpMRI) with PI-RADS scoring and targeted biopsy, enhance detection of clinically significant prostate cancer (csPCa), reduce unnecessary procedures, and minimize complications. Objective . To evaluate the efficacy of transrectal mpMRI/transrectal ultrasound (TRUS) fusion-guided prostate biopsy in detecting csPCa. Materials & methods . We prospectively evaluated 318 patients who underwent transrectal mpMRI/TRUS fusion-guided prostate biopsy. All patients had pre-biopsy mpMRI with PI-RADS scoring, prostate-specific antigen (PSA) levels, PSA density, and digital rectal examination (DRE). Biopsies employed a combined approach: targeted sampling of mpMRIidentified lesions plus systematic sampling. Prostate cancer detection rates (csPCa defined as ISUP grade ≥ 2) were correlated with PI-RADS score, PSA density, and DRE findings. Detection rates were compared between biopsy-naïve and repeat-biopsy patients. Complications were systematically recorded. Results . csPCa was detected in 40% of patients overall (43% in biopsy-naïve vs. 35% in repeat-biopsy patients; p > 0.05). Lesions scored PI-RADS 4 – 5 yielded significantly higher csPCa detection rates than PI-RADS 3 lesions. Among PI-RADS 3 cases, PSA density > 0.15 ng/mL/cm³ predicted higher csPCa risk, while lower values indicated low risk. Positive DRE also correlated with csPCa detection. Targeted biopsy detected most csPCa cases, but systematic sampling increased the overall yield by 10%. No severe complications (e.g., sepsis or major hemorrhage) occurred; minor, transient events such as hematuria or fever affected < 5% of patients. Conclusions . Transrectal mpMRI/TRUS fusion-guided biopsy is highly effective for csPCa detection. Pre-biopsy mpMRI combined with targeted plus systematic sampling optimizes diagnostic yield while maintaining a favorable safety profile.

Aim. To perform systematic review of the literature published in 2000–2024 and meta-analysis of the data according to the PRISMA protocol 2020. Materials and methods. Data on clinical cases of 60 patients with prostate cancer metastases to ocular structures (orbit or eye) reported from 2000 to 2024 were analyzed. The resulting cohort is the largest on this topic in the last two decades. Results. Prostate cancer metastases most frequently involved the orbit (including the optic nerve) and choroid; involvement of the iris or ciliary body was rare. In 17 % of patients, ocular symptoms were the first manifestation leading to a prostate cancer diagnosis. The optimal treatment approach was a combination of systemic prostate cancer therapy (androgen deprivation ± chemotherapy) with local ocular radiotherapy. Hormone therapy played a key role in prolonging survival and improving quality of life, whereas orbital radiation was effective for palliating symptoms and partially restoring vision. The median survival after detection of ocular metastases was approximately 6–12 months. Conclusion. Ocular metastases of prostate cancer are an extremely rare but clinically significant condition. Timely diagnosis and combined systemic and local treatment may improve the prognosis and quality of life of such patients despite an overall poor outcome. Limitations. The retrospective and heterogeneous nature of available data, small sample size (60 cases), and potential publication bias limit the generalizability of the results.

Prostate cancer is one of the most frequently diagnosed oncological diseases worldwide and in the Russian Federation. Modern extended pelvic lymph node dissection is the most reliable method for detecting metastases in regional lymph nodes in patients with prostate cancer. However, this method is associated with certain risks both during the operation and in the postoperative period, which encourages researchers to develop alternative diagnostic approaches. One such alternative is sentinel lymph node biopsy, which demonstrates high potential in diagnostics. At the same time, a number of factors must be considered: limited number of randomized clinical trials, diversity of protocols used, variability of radioisotope and tracer combinations, as well as the need to consider both instrumental and clinical data. For the widespread implementation of this approach in clinical practice, further scientific research is required, including studies conducted in Russia.