Prostate cancer ranks among the most prevalent tumours globally. While early detection reduces the likelihood of metastasis, managing advanced cases poses challenges in diagnosis and treatment. Current international guidelines support the concurrent use of ⁹⁹Tc-Bone Scintigraphy and Contrast-Enhanced Chest and Abdomen CT for the staging of metastatic disease and response assessment. However, emerging evidence underscores the superiority of next-generation imaging techniques including PSMA-PET/CT and whole-body MRI (WB-MRI). This review explores the relevant scientific literature on the role of WB-MRI in metastatic prostate cancer. This multiparametric imaging technique, combining the high anatomical resolution of standard MRI sequences with functional sequences such as diffusion-weighted imaging (DWI) and bone marrow relative fat fraction (rFF%) has proved effective in comprehensive patient assessment, evaluating local disease, most of the nodal involvement, bone metastases and their complications, and detecting the increasing visceral metastases in prostate cancer. It does have the advantage of avoiding the injection of contrast medium/radionuclide administration, spares the patient the exposure to ionizing radiation, and lacks the confounder of FLARE described with nuclear medicine techniques. Up-to-date literature regarding the diagnostic capabilities of WB-MRI, though still limited compared to PSMA-PET/CT, strongly supports its widespread incorporation into standard clinical practice, alongside the latest nuclear medicine techniques.

Background/Objectives: Adverse in-hospital outcomes at radical prostatectomy have not been specifically addressed in young patients aged 40–49 years (quadragenarians). Additionally, no comparison between robot-assisted (RARP) vs. open radical prostatectomy (ORP) has been reported in this population. Methods: Descriptive analyses, propensity score matching (PSM), and multivariable logistic/Poisson regression models addressed quadragenarians undergoing RARP or ORP within the National Inpatient Sample (2009–2019). Results: Of 5426 quadragenarians, 4083 (75.2%) and 1343 (24.8%) underwent RARP and ORP, respectively. The proportion of RARP increased from 68.1 to 84.5% (2009–2019, EAPC: +2.8%, p < 0.001). Adverse in-hospital outcomes after RARP were invariably lower than those after ORP. Specifically, the rates of overall complications (7.8 vs. 13.4%, Δ −5.6%, multivariable odds ratio (OR): 0.54), blood transfusions (1.2 vs. 6.3%, Δ −5.1%, OR: 0.21), and length of stay (LOS) > 2 days (10.6 vs. 28.7%, Δ −18.1%, OR: 0.32) were lower after RARP than after ORP (all p < 0.001). After additional one-to-one PSM between ORP and RARP patients, virtually the same results were reported (overall complications: 7.0 vs. 13.4%, Δ −6.4%, OR: 0.49; blood transfusion rates: 1.5 vs. 6.3%, Δ −4.8%, OR: 0.23; LOS > 2 days: 10.9 vs. 28.7%, Δ −17.8%, OR: 0.30). Conversely, RARP use resulted in higher total hospital charges (USD 43,690 vs. 36,840, Δ USD +6850, IRR: 1.18; p < 0.001). Conclusions: Quadragenarians exhibited a more favorable adverse in-hospital outcome profile after RARP vs. ORP. These advantages are offset by a small, albeit significant, increase in total hospital charges.

Background: Rates and predictors of open conversion at robotic adrenalectomy (rRA) are unknown. Methods: We identified patients treated with rRA (National Inpatient Sample 2009‐2019). First, temporal trends in open conversion were assessed using Estimated Annual Percentage Changes (EAPC). Second, multivariable logistic regression models were used to identify predictors of open conversion during rRA. Results: Of 2,292 rRA patients, 286 (12.0%) underwent open conversion. The rates of open conversion decreased over time from 39.2% to 10.2% over the study span (EAPC −15.9%; p = 0.0003). Open conversion patients during rRA were more frequently male (59.0 vs. 53.0%; p = 0.04) and had more comorbidities (Charlson Comorbidity Index [CCI] ≥ 4: 28.0 vs. 17.0%; p < 0.001). In multivariable logistic regression models predicting open conversion, CCI ≥ 4 versus 0‐3 (OR: 2.0; p < 0.001) and low versus medium‐high surgical volume hospital (OR: 2.0; p < 0.001) were independent predictors. A dose‐response effect was observed when CCI and hospital volume were combined. Specifically, the rates of open conversion were respectively 13.9 versus 25.9% in patient with CCI 0‐3 versus CCI ≥ 4 at low surgical volume hospitals ( p < 0.001). Conversely, the rates of open conversion were respectively 7.7 versus 13.4% in patient with CCI 0‐3 versus CCI ≥ 4 at medium‐high surgical volume hospitals ( p < 0.001). Conclusion: The rate of open conversion at rRA significantly decreased over time from 39.2% to 10.2%. Individuals at particularly elevated risk consisted of patients with CCI ≥ 4 in whom rRA is contemplated at low‐volume hospitals (25.9%). Relegation of such individuals to medium‐high surgical volume hospitals may reduce the conversion rate by half (13.4%).