To examine the role of multiparametric magnetic resonance imaging (mpMRI) in enhancing prostate cancer (PCa) detection and selecting candidates for active surveillance (AS), given that its utility in monitoring disease progression remains unclear. The Miami Active Surveillance Trial (MAST) is a prospective trial of men undergoing serial mpMRI and biopsies on AS for PCa. Participants had annual mpMRI with MRI-targeted and systematic biopsies at confirmatory (12-18 months) and subsequent intervals (12, 24, and 36 months). Grade progression was defined as an upgrade from Grade Group (GG) 1 to GG ≥2 or GG 2 to GG ≥3. The performance of MRI was evaluated at baseline (prior to confirmatory biopsy) and on subsequent biopsies for association with grade progression. Fine and Gray competing-risk models evaluated MRI for predicting grade progression after controlling for risk factors. Among 205 men, 79 (38.5%) had grade progression at the conclusion of the trial (36 months), with 40 (19.5%) men having grade progression at confirmatory biopsy, and the remaining 39 (2.0-9.8%/year) progressing on subsequent biopsies. A Prostate Imaging-Reporting And Data System (PI-RADS) score of 4 or 5 (vs no suspicious lesions or PI-RADS 1 and 2) on baseline MRI (prior to confirmatory biopsy) was an independent predictor of grade progression on confirmatory biopsy (Gray's test P < 0.001), with volume progression treated as a competing risk. At 36 months, MRI-only surveillance would have avoided 45% of biopsies but missed 32% of progression events. Pre-confirmatory biopsy MRI independently predicted grade progression on confirmatory and subsequent biopsies during AS; however, false positives and negatives still occur highlighting the need for periodic biopsy of the prostate.

To evaluate the utility of tumour size, R.E.N.A.L. (Radius, Exophytic/Endophytic, Nearness to collecting system or sinus, Anterior/Posterior, Location), PADUA (Preoperative Aspects and Dimensions Used for an Anatomical), and SPARE (Simplified PADUA R.E.N.A.L.) nephrometry scoring systems (NSs) in predicting the likelihood of achieving trifecta and pentafecta outcomes, as well as the risk of postoperative acute kidney injury (AKI) and kidney disease progression at 12 months following robot-assisted partial nephrectomy (RAPN). Retrospective review was performed on Institutional Review Board-approved, prospectively maintained database to identify all cases of primary, non-metastatic renal masses who underwent RAPN between 2011 and 2024. All preoperative radiological images were reviewed by a single resident physician, who characterised all tumours based on the NSs. Trifecta outcome was defined as cases with warm ischaemia time of <25 min, negative surgical margin, and absence of complications. Pentafecta included the trifecta outcomes with the addition of >90% renal function preservation and absence of kidney disease progression at 12 months. Logistic regression and receiver operating characteristic (ROC) analyses were completed to determine the predictive ability for the tumour size and each of the NSs. Based on 1787 patients, trifecta and pentafecta were achieved in 52.7% and 22.2%, respectively. All three NSs were established as significant predictors of trifecta, pentafecta, and postoperative AKI, with all demonstrating comparable yet limited predictive performance (area under the ROC curve [AUC] 0.573-0.645). Tumour diameter (AUC 0.649-0.665) was shown to outperform the NSs in predicting the likelihood of achieving trifecta and pentafecta, as well as the risk of AKI. None of the NSs were identified as predictors of kidney disease progression at 12 months. Although lower R.E.N.A.L., PADUA, and SPARE NSs were associated with achieving surgical success and reduced risk of AKI, their predictive performance was modest and can be outperformed by a simpler and more objective measure, such as tumour diameter. Future studies remain necessary to re-evaluate the broader clinical utility of NSs in predicting surgical and functional outcomes, in addition to its original purpose as standardized tools for the anatomical characterization of renal tumours.

To assess prostate volume (PV) changes with age in symptomatic and asymptomatic men with and without clinically significant prostate cancer (csPCa). In symptomatic patients, we additionally analysed the effect of age and csPCa on PSA and PSA-density (PSA-D) and compared these to current National Institute for Health and Care Excellence (NICE) recommended PSA age-range thresholds. Patients and Methods This single-centre retrospective cross-sectional study included 2512 men: 760 asymptomatic, disease-free men and 1752 patients referred on a PCa diagnostic pathway. Magnetic resonance imaging-derived whole-gland PV was recorded for all patients. A machine-learning pipeline with k-fold cross validation modelled relationships between PV and age. In asymptomatic men (median PV 25.4 mL), the mean PV per age-group increased non-linearly with age, from 18.7 mL at an increase of 0.10 mL/year aged 18 years, to 41.3 mL at 0.68 mL/year aged 89 years, with increased rate of change from the age of 48.9 years. Significant positive relationships were shown between PSA and age in patients with and without csPCa (r2 = 0.09 vs 0.13, respectively), with PSA increasing by mean 0.17 ng/mL/year across groups. Patients with csPCa had consistently higher PSA levels. PSA-D showed significant age-related linear increases in patients with csPCa but remained consistently lower in those without csPCa at all ages (0.10-0.11 ng/mL2), allowing differentiation at a threshold of >0.15 ng/mL2. In asymptomatic men, PV changed non-linearly with age. Age-related PSA thresholds are supported; however, a static PSA-D threshold of 0.15 ng/mL2 can be applied across all age ranges.

To establish a UK consensus vision of a standardised genomic testing pathway in unresectable/metastatic urothelial cancer (mUC) with clear roles and responsibilities for multidisciplinary team (MDT) members and molecular pathology laboratory teams, and to agree how the pathway must evolve to accommodate emerging innovations. A modified Delphi method was used. Six healthcare professionals (HCPs) with expertise in UC formed the Steering Committee (SC), which met in May 2025. Seven key consensus topics were developed covering the steps of the pre-testing and genomic testing pathways, the current and future state of precision medicine, and approaches to overcome barriers and ensure readiness for the future. Within these topics, statements were developed and distributed to clinical scientists and HCPs via an on-line 4-point Likert scale survey. Respondents could opt out of responding to statements outside their area of expertise. Consensus was pre-defined as ≥75% agreement. Overall, 50 responses were received; consensus was reached on 41/42 statements. The statement that did not achieve consensus was part of a paired set. A proposed pathway for pre-testing and genomic testing in unresectable or mUC was developed based on survey results and discussions at SC meetings. Key priorities for the pathway include: timely fibroblast growth factor receptor 3 testing, ideally at the commencement of first-line systemic therapies; selection of specimens based on volume of tissue and recency; immediate access to the genomic testing report for all MDT members; and secure data environments with federated access to genomic results. Since the stopping criteria were met, no further survey rounds were required. Adopting the genomic testing pathway derived from this Delphi consensus will provide greater clarity around MDT and molecular laboratory responsibilities, reduce regional inequities in access, and optimise patient outcomes through timely delivery of genomic testing and subsequent treatment.

To systematically evaluate management strategies and associated outcomes of iatrogenic ureteric injuries, focusing on clinical success, renal unit loss, and the need for subsequent endoscopic or reconstructive procedures. A pre-registered protocol (CRD420251184018) guided a comprehensive search of PubMed and EMBASE databases. Observational studies reporting outcomes of ≥20 patients treated for iatrogenic ureteric injury with complete data on follow-up were included. Risk of bias was assessed using Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I). Random-effects meta-analysis with PLOGIT transformation was applied, stratifying results by treatment type and timing. Meta-regression examined the association of treatment modality with outcomes adjusting for the timing of reconstruction. A total of 30 studies were included (1517 patients), all retrospective and characterised by substantial heterogeneity in definitions and follow-up practices. ROBINS-I indicated serious risk of bias in most domains. The pooled clinical success rate was 87% (95% confidence interval [CI] 80-91%), with high heterogeneity I2 = 76.0% due to different follow-up protocols, success outcomes, type and timing of management. Studies dominated by reconstructive procedures (15 studies) had higher success (91%, 95% CI 84-95%), than those primarily using endoscopic techniques (six studies; 66%, 95% CI 58-73%). Renal unit loss occurred in 2.3% (95% CI 1.5-3.6%). No differences in loss of renal unit were found. Additional endoscopic interventions were required in 3% (95% CI 2-4%) and further reconstructive surgery in 5% (95% CI 3-9%). Meta-regression showed endoscopic index management was associated with lower odds of success (odds ratio [OR] 0.14, 95% CI 0.05-0.40) and higher need for further reconstruction (OR 5.64, 95% CI 1.61-19.8). Across retrospective and heterogeneous studies, reconstructive-dominant management of iatrogenic ureteric injuries was associated with higher clinical success compared with endoscopic-dominant approaches, while renal unit loss remained uncommon. Endoscopic management was feasible in selected cases but was more frequently followed by additional endoscopic or reconstructive interventions.