Background: The most recent overall survival (OS) and adverse event (AE) data have not been compared for the three guideline-recommended high-risk non-metastatic castration-resistant prostate cancer (nmCRPC) treatment alternatives. Methods: We performed a systematic review and network meta-analysis focusing on OS and AE according to the most recent apalutamide, enzalutamide, and darolutamide reports. We systematically examined and compared apalutamide vs. enzalutamide vs. darolutamide efficacy and toxicity, relative to ADT according to PRISMA. We relied on PubMed search for most recent reports addressing prospective randomized trials with proven predefined OS benefit, relative to ADT: SPARTAN, PROSPER, and ARAMIS. OS represented the primary outcome and AEs represented secondary outcomes. Results: Overall, data originated from 4117 observations made within the three trials that were analyzed. Regarding OS benefit relative to ADT, darolutamide ranked first, followed by enzalutamide and apalutamide, in that order. In the subgroup of PSA-doubling time (PSA-DT) ≤ 6 months patients, enzalutamide ranked first, followed by darolutamide and apalutamide in that order. Conversely, in the subgroup of PSA-DT 6–10 months patients, darolutamide ranked first, followed by apalutamide and enzalutamide, in that order. Regarding grade 3+ AEs, darolutamide was most favorable, followed by enzalutamide and apalutamide, in that order. Conclusion: The current network meta-analysis suggests the highest OS efficacy and lowest grade 3+ toxicity for darolutamide. However, in the PSA-DT ≤ 6 months subgroup, the highest efficacy was recorded for enzalutamide. It is noteworthy that study design, study population, and follow-up duration represent some of the potentially critical differences that distinguish between the three studies and remained statistically unaccounted for using the network meta-analysis methodology. Those differences should be strongly considered in the interpretation of the current and any network meta-analyses.

Background: Recently, an increase in the rates of high‐risk prostate cancer (PCa) was reported. We tested whether the rates of and low, intermediate, high and very high‐risk PCa changed over time. We also tested whether the number of prostate biopsy cores contributed to changes rates over time.Methods: Within the Surveillance, Epidemiology and End Results (SEER) database (2010–2015), annual rates of low, intermediate, high‐risk according to traditional National Comprehensive Cancer Network (NCCN) and high versus very high‐risk PCa according to Johns Hopkins classification were tabulated without and with adjustment for the number of prostate biopsy cores.Results: In 119,574 eligible prostate cancer patients, the rates of NCCN low, intermediate, and high‐risk PCa were, respectively, 29.7%, 47.8%, and 22.5%. Of high‐risk patients, 39.6% and 60.4% fulfilled high and very high‐risk criteria. Without adjustment for number of prostate biopsy cores, the estimated annual percentage changes (EAPC) for low, intermediate, high and very high‐risk were respectively −5.5% (32.4%–24.9%, p < .01), +0.5% (47.6%–48.4%, p = .09), +4.1% (8.2%–9.9%, p < .01), and +8.9% (11.8%–16.9%, p < .01), between 2010 and 2015. After adjustment for number of prostate biopsy cores, differences in rates over time disappeared and ranged from 29.8%–29.7% for low risk, 47.9%–47.9% for intermediate risk, 8.9%–9.0% for high‐risk, and 13.6%–13.6% for very high‐risk PCa (all p > .05).Conclusions: The rates of high and very high‐risk PCa are strongly associated with the number of prostate biopsy cores, that in turn may be driven by broader use magnetic resonance imaging (MRI).

Objectives: To quantify the magnitude of differences between observed overall survival and respective, age‐adjusted Social Security Administration life tables‐derived life expectancy in Caucasian, African American, Hispanic/Latino and Asian metastatic prostate cancer patients. Furthermore, to test for differences in cancer‐specific mortality and other‐cause mortality according to race/ethnicity.Methods: We relied on the 2004–2006 Surveillance, Epidemiology and End Results database to identify Caucasian, African American, Hispanic/Latino and Asian metastatic prostate cancer patients. Social Security Administration life tables were used to compute 10‐year life expectancy for comparisons with observed overall survival. Poisson regression plots showed cancer‐specific mortality relative to other‐cause mortality for each race/ethnicity.Results: A total of 2574 (64.2%) patients were Caucasian, 753 (18.8%) were African American, 453 (11.3%) were Hispanic/Latino and 227 (5.7%) were Asian, respectively. The median age at diagnosis was 72 years in Caucasian patients, 68 years in African American patients, 70 years in Hispanic/Latino patients and 72 years in Asian patients. Observed overall survival rates were always lower compared with respective predicted life expectancy. The magnitude of the difference between observed overall survival and predicted life expectancy at 10 years was highest in African American patients (−52.2%), followed by Caucasian patients (−48.3%), Hispanic/Latino patients (−46.1%) and Asian patients (−37.4%). African American patients showed the highest cancer‐specific mortality rates (71.1%) and second‐highest other‐cause mortality rates (17.4% vs highest 18.4% in Caucasian patients), despite having the youngest age at diagnosis. Asian patients showed the lowest cancer‐specific mortality rates (65.5%, P < 0.0001) and lowest other‐cause mortality rates (13.3%, P = 0.04), despite having the oldest age at diagnosis.Conclusions: Despite having the youngest age at diagnosis, African American patients show the least favorable survival profile in metastatic prostate cancer. Conversely, Asian patients show the most favorable survival profile in metastatic prostate cancer, despite having the oldest age at diagnosis.

Background: Laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) are commonly used techniques for treating small renal masses. Regarding renal function (RF) preservation, no superiority of one technique over the other has yet been definitely demonstrated. Objective: To compare functional and surgical outcomes of LPN and RAPN. Patients and Methods: Between 2015 and 2019, we prospectively randomized 115 patients with cT1–T2 renal masses to LPN in total ischemia or RAPN in selective ischemia. Primary endpoint was RF preservation, assessed by renal scintigraphy (RS). RS assessments were performed preoperatively and at 6 months follow-up. Secondary endpoints included clinical, histopathologic, and surgical outcomes. Results: One hundred eight patients were included in the final analysis. Patient and tumor characteristics were comparable. No significant difference in RS values after 6 months was observed between both groups. Median (interquartile range) RF change after 6 months was −18.0% (−26.5 to −11.0) in LPN group and −20.0 (−33.2 to −12.0) in RAPN group ( p = 0.3). Mean (standard deviation [SD]) warm ischemia time was 21.1 (6.1) minutes in LPN group and 19.6 (7.7) minutes in RAPN group ( p = 0.2). No positive surgical margins (PSMs) occurred in the LPN group, whereas RAPN group had PSM in 4.9% ( n = 3); p = 0.099. Renal volume loss after 6 months was 27.5% (22.7–45.7) in the LPN group vs 37.5 (13.7–54.2) in the RAPN group ( p = 0.5). Mean operative times were lower in the LPN group (192.3 minutes [SD 44.5] vs 230.2 minutes [SD 59.6], p = 0.001). More complications occurred in the LPN group (31% vs 21%, p = 0.075). Transfusion rates were 15% for LPN and 11% for RAPN. Conclusions: In terms of preserving RF, LPN in total ischemia and RAPN in selective ischemia are comparable. In most patients, RF decrease of the affected kidney after PN seems to not exceed 25%, regardless of the surgical approach.