Background: Prostate cancer (PCa) management is moving towards patient-tailored strategies. Advances in molecular and genetic profiling of tumor tissues, integrated with clinical risk assessments, provide deeper insights into disease aggressiveness. This study aims to offer a comprehensive overview of the pivotal genomic tests supporting PCa treatment decisions, analyzing—through real-world data—trends in their use and the growth of supporting literature evidence. Methods: A retrospective analysis was conducted using the extensive PearlDiver™ Mariner database, which contains de-identified patient records, in compliance with the Health Insurance Portability and Accountability Act (HIPAA). The International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify patients diagnosed with PCa during the study period—2011 to 2021. We determined the utilization of primary tissue-based genetic tests (Oncocyte DX^®, Prolaris^®, Decipher^®, and ProMark^®) across all patients diagnosed with PCa. Subsequently, within the overall PCa cohort, patients who underwent radical prostatectomy (RP) and received genetic testing postoperatively were identified. The yearly distribution of these tests and the corresponding trends were illustrated with graphs. Results: During the study period, 1,561,203 patients with a PCa diagnosis were recorded. Of these, 20,748 underwent tissue-based genetic testing following diagnosis, representing 1.3% of the total cohort. An increasing trend was observed in the use of all genetic tests. Linear regression analysis showed a statistically significant increase over time in the use of individual tests (all p-values < 0.05). Among the patients who underwent RP, 3076 received genetic analysis following surgery, representing 1.27% of this group. Conclusions: Our analysis indicates a growing trend in the utilization of tissue-based genomic testing for PCa. Nevertheless, they are utilized in less than 2% of PCa patients, whether at initial diagnosis or after surgical treatment. Although it is anticipated that their use may increase as more scientific evidence becomes available, their role requires further elucidation.

Male urinary incontinence is a common complication after radical prostatectomy. The severity of incontinence can be assessed in various ways and helps determine the best surgical intervention to restore continence. While most patients with mild incontinence receive a sling and those with severe incontinence receive an artificial urinary sphincter (AUS), there are no clear guidelines on how to manage patients with moderate post-prostatectomy incontinence (PPI). Our discussion will focus on the current literature, which demonstrates that an AUS should be considered first-line in men with moderate PPI despite perceived concerns over complications and reintervention rates.

Men undergoing surgical correction of Peyronie’s disease (PD) have had intraoperative identification of a glans tilt or floppy glans not recognized preoperatively. To describe the outcomes of a novel modified glanspexy performed on a large cohort of men with PD who also underwent a partial plaque excision or incision and grafting, tunica albuginea plication, or inflatable penile prosthesis (IPP) with straightening maneuvers. A retrospective analysis (2016-2021) was performed on all patients who presented to a single surgeon with PD and were treated with a surgical procedure that included a glanspexy. Patients were tracked longitudinally, and interventions and outcomes were collected. All glanspexies were performed with the same surgical technique, where the glans was secured over the tips of the corpora cavernosa with several 4-0 Monocryl sutures between the glans and the tunica albuginea contralateral to the tilt through a subcoronal incision. Our novel modified glanspexy technique resulted in excellent postoperative results with a high rate of durable repair. A total of 88 glanspexies were performed during surgery for PD with a median follow-up of 9 months (range, 1-77). All patients underwent a glanspexy plus partial plaque excision or incision and grafting (34.1%), tunica albuginea plication (10.2%), or an IPP with straightening maneuvers (55.7%). The most common direction of the glans tilt was dorsal (78.8%). Glanspexies were successful in 97.3% of patients, as only 2 (2.7%) had recurrent glans deformity >20° during the follow-up period. Our glanspexy technique repaired the glans deformity without compromising sensitivity or sexual function. Sensory complaints were noted in 1 patient (1.1%), who complained of hypoesthesia of the glans; however, there was no adverse effect on orgasm or ejaculation. A repeat glanspexy for recurrent glans deformity was performed on 1 patient (1.1%). While most literature focuses on glanspexy after IPP placement, our article provides evidence for use of our glanspexy technique to repair glans hypermobility in patients with PD. Our data are strengthened by the relatively large sample population and consistent outcomes regardless of straightening maneuver used. Conclusions regarding glanspexy and long-term satisfaction are limited by the lack of a validated questionnaire to illicit satisfaction during the postoperative period. Glanspexy with 4-0 Monocryl suture on a TF needle appears to be a safe, easy, minimally invasive, and effective technique for the treatment of a glans tilt or floppy glans identified during the surgical management of PD.