Objectives: To determine the safety, quality of life (QoL) and short‐term oncological outcomes of primary focal irreversible electroporation ( IRE ) for the treatment of localized prostate cancer ( PC a), and to identify potential risk factors for oncological failure. Patients and Methods: Patients who met the consensus guidelines on patient criteria and selection methods for primary focal therapy were eligible for analysis. Focal IRE was performed for organ‐confined clinically significant PC a, defined as high‐volume disease with Gleason sum score 6 (International Society of Urological Pathology [ ISUP ] grade 1) or any Gleason sum score of 7 ( ISUP grades 2–3). Oncological, adverse event ( AE ) and QoL outcome data, with a minimum of 6 months’ follow‐up, were analysed. Patient characteristics and peri‐operative treatment variables were compared between patients with and without oncological failure on follow‐up biopsy. Wilcoxon's signed rank test, Wilcoxon's rank sum test and the chi‐squared test were used to assess statistically significant differences in paired continuous, unpaired continuous and categorical variables respectively. Results: A total of 63 patients met all eligibility criteria and were included in the final analysis. No high‐grade AE s occurred. QoL questionnaire analysis demonstrated no significant change from baseline in physical ( P = 0.81), mental ( P = 0.48), bowel ( P = 0.25) or urinary QoL domains ( P = 0.41 and P = 0.25), but there was a mild decrease in the sexual QoL domain (median score 66 at baseline vs 54 at 6 months; P < 0.001). Compared with baseline, a decline of 70% in prostate‐specific antigen level (1.8 ng/mL, interquartile range 0.96–4.8 ng/mL) was seen at 6–12 months. A narrow safety margin ( P = 0.047) and system errors ( P = 0.010) were identified as potential early risk factors for in‐field oncological failure. In‐field and whole‐gland oncological control on follow‐up biopsies was 84% (38/45 patients) and 76% (34/45 patients); this increased to 97% (38/39 patients) and 87% (34/39 patients) when patients treated with a narrow safety margin and system errors were excluded. Conclusion: Our data support the safety and feasibility of focal IRE as a primary treatment for localized PC a with effective short‐term oncological control in carefully selected men.

Objectives: To evaluate the safety and short‐term oncological outcomes of ⁶⁸ gallium‐labelled prostate‐specific membrane antigen ( ⁶⁸ Ga‐ PSMA ) positron‐emission tomography ( PET )/computed tomography ( CT )‐directed robot‐assisted salvage node dissection ( RASND ) for prostate cancer oligometastatic nodal recurrence. Materials and Methods: Between February 2014 and April 2016, 35 patients across two centres underwent RASND for ⁶⁸ Ga‐ PSMA PET / CT ‐detected oligometastatic nodal recurrence. RASND was performed using targeted pelvic dissection, unilateral extended pelvic template or bilateral extended pelvic template dissection, depending on previous pelvic treatment and extent/location of nodal disease. Complications were reported using the Clavien–Dindo classification system. Definitions of prostate‐specific antigen ( PSA ) treatment response to RASND were defined as 6‐week PSA <0.2 ng/ mL (broad definition) or PSA <0.05 ng/ mL (strict definition) in those who had undergone primary prostatectomy, and 6‐week PSA level < post‐radiotherapy nadir in those who had undergone primary radiotherapy. Biochemical recurrence ( BCR ) after RASND was defined as a PSA >0.2 ng/ mL or PSA > nadir, for those who had undergone primary prostatectomy and primary radiotherapy, respectively. Predictors of treatment response were analysed using univariate binary logistic regression. Results: A total of 58 lesions suspicious for lymph node metastases ( LNM ) in 35 patients were detected on ⁶⁸ Ga‐ PSMA imaging. A total of 32 patients (91%) had histopathologically proven LNM at RASND , with a total of 87 LNM and a median (interquartile range) of 2 (1–3) LNM per patient. In all, eight patients (23%) experienced complications, all Clavien–Dindo grade ≤2. Treatment response was seen in 15 (43%) and 11 patients (31%), using the broad and strict definitions, respectively. BCR ‐free survival and clinical recurrence‐free survival at a median follow‐up of 12 months were 23% and 66%, respectively, for the entire cohort. Bilateral template dissection was the only significant univariate predictor of treatment response in our cohort. Conclusions: Although RASND appears safe and feasible, less than half of our cohort had a treatment response, and less than a quarter experienced BCR ‐free survival at 12‐month median follow‐up. ⁶⁸ Ga‐ PSMA imaging underestimates micro‐metastatic disease, therefore RASND will rarely be curative. Strict patient selection and restricting RASND to clinical trials is recommended. Long‐term follow‐up from such trials is required to further assess potential quality of life and mortality benefits.

Diagnostic and Interventional Radiology

Background: Despite being a potentially attractive alternative molecular imaging modality due to wider availability and association with lethal disease in advanced prostate cancer, the role of fluorodeoxyglucose (FDG)- positron emission tomography (PET) at initial diagnosis compared to Prostate Specific Membrane Antigen (PSMA) PET is yet to be accurately determined. The aim of this study was to evaluate the additive benefit of FDG PET to PSMA PET in patients with newly diagnosed, high risk prostate cancer. Results: A prospective trial conducted across three sites between October-2021 and January-2023 recruited 32 participants with high risk (EAU classification) prostate cancer staged with PSMA PET-CT. FDG PET-CT was acquired centrally and reported with a standardised template. Median age was 69 years, median PSA was 14 ug/L, and most had PI-RADS 5 scores (59%) and ISUP Grade Group 5 tumours (66%). Overall, FDG-PET did not detect any additional definite/probable metastasis according to physician interpretation. All tumours showed PSMA avidity and higher stage was observed per PSMA-PET in 5 participants. No FDG uptake at the primary tumour occurred in 34% of participants. FDG-PET did not result in a change in management for any participant. PSA remission rates were lower in patients with stage ≥ 3 tumours on MRI (60% vs 94%, p = 0.04). Patient reported outcomes (PROs) were largely stable throughout the study. Conclusions: FDG-PET did not provide additive staging information above PSMA-PET or alter management for newly diagnosed high-risk prostate cancer patients. Trial registration number : ANZCTR ACTRN12621001185853. Registered 03–09-2021. Available at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382299

Primary sarcomatoid urothelial carcinoma of the ureter with heterologous elements is rare and carries a poor prognosis. Although there is some literature on primary bladder sarcomatoid urothelial carcinoma, ureteric involvement has been reported infrequently, and this case report describes this unusual histological finding with concurrent divergent squamous differentiation. Despite laparoscopic radical nephroureterectomy, our patient died within six months of diagnosis with local recurrence and metastatic spread. A more thorough understanding of this disease process and consideration of standardised guidelines for treatment are needed to improve patient outcomes.