Background Dysregulated lipid metabolism is associated with more aggressive pathology and poorer prognosis in prostate cancer (PC). The primary aim of the study is to assess the relationship between the plasma lipidome and clinical outcomes in localised and metastatic PC. The secondary aim is to validate a prognostic circulating 3-lipid signature specific to metastatic castration-resistant PC (mCRPC). Patients and methods Comprehensive lipidomic analysis was performed on pre-treatment plasma samples from men with localised PC (N = 389), metastatic hormone-sensitive PC (mHSPC)(N = 44), or mCRPC (validation cohort, N = 137). Clinical outcomes from our previously published mCRPC cohort (N = 159) that was used to derive the prognostic circulating 3-lipid signature, were updated. Associations between circulating lipids and clinical outcomes were examined by Cox regression and latent class analysis. Results Circulating lipid profiles featuring elevated levels of ceramide species were associated with metastatic relapse in localised PC (HR 5.80, 95% CI 3.04–11.1, P = 1 × 10⁻⁶), earlier testosterone suppression failure in mHSPC (HR 3.70, 95% CI 1.37–10.0, P = 0.01), and shorter overall survival in mCRPC (HR 2.54, 95% CI 1.73–3.72, P = 1 × 10⁻⁶). The prognostic significance of circulating lipid profiles in localised PC was independent of standard clinicopathological and metabolic factors (P < 0.0002). The 3-lipid signature was verified in the mCRPC validation cohort (HR 2.39, 95% CI 1.63–3.51, P = 1 × 10⁻⁵). Conclusions Elevated circulating ceramide species are associated with poorer clinical outcomes across the natural history of PC. These clinically actionable lipid profiles could be therapeutically targeted in prospective clinical trials to potentially improve PC outcomes.

Urology’s pioneering role in surgical innovations, from cystoscopy to laparoscopic surgery, culminated in the twenty-first-century advent of robotic surgery. The dominant da Vinci^® system faced new competition following its 2019 patent expiration. Medtronic’s Hugo^™ system emerged. Its growing global adoption, especially in robot-assisted radical prostatectomy (RARP), necessitates a systematic review, evaluating safety, feasibility, and comparison with established systems. A comprehensive search identified eligible studies of the Hugo^™ robotic platform for RARP, presenting their current experiences. Following systematic screening, quality of eligible studies was assessed using ROBINS-I. Results then underwent a narrative synthesis. This systematic review analysed 19 eligible studies, consisting of 9 comparative and 10 single arm studies. Due to the non-randomised nature of the studies, a moderate risk of bias was concluded in most. On account of the high heterogeneity between studies, a narrative synthesis of data was enacted; categorised into themes relating to operative timings, transfer of skills, patient demographics, plus safety and feasibility. Eligible studies demonstrated the promise of the Hugo^™ platform within these themes, in comparison to currently available platforms. Despite a paucity of high-quality randomised controlled trials, available evidence indicates Hugo^™ as a promising, safe alternative for RARP. Positive experiences across diverse centres and surgeons revealed minimal differences in surgical outcomes compared to the established da Vinci^® system, fostering global Hugo^™ adoption. Despite evidence demonstrating Hugo^™ safety and comparability, the review underscores the scarcity of high-quality evidence, attributing it to early stage implementation challenges.

Objectives: To assess the feasibility and safety of the new Hugo robotic-assisted surgery (RAS) system for robotic-assisted radical prostatectomy (RARP), describing iterative changes in our operative technique—IDEAL stage 2. Design: Prospective, single-centre series. Setting: Tertiary urological unit in London, UK. Participants: Male patients diagnosed with clinically localised prostate cancer and suitable for RARP from February 2023 to May 2024. Main outcome measures: The primary outcome was to assess the safety of using the device without converting to the existing robotic platform (da Vinci), laparoscopy or open. Secondary outcomes assessed surgical (operative time, blood loss, time to catheter removal, complications), oncologic (surgical pathology and margin status) and early functional (continence) outcomes. Results: 50 patients were included in the study. No cases required conversion to an existing robotic platform, laparoscopy or open, and there were no intraoperative surgical complications. Mean age was 60 years and mean prostate-specific antigen was 12.2 ng/mL. The mean operative time was 148 min and estimated blood loss was 168 mL. Mean length of stay was 1.5 days and mean length of catheter duration was 13 days. On final pathology, 18 patients (36%) had T3 disease and four had positive surgical margins (8%). The mean International Consultation on Incontinence Questionnaire–Urinary Incontinence score for urinary continence at 3 months was 7. There were six Clavien-Dindo grade 2 complications and two Clavien-Dindo 3a complications. There were four instances of recoverable, temporary device failure. Iterative improvements were made to docking setup, use of robotic instruments and reduction in robotic arm collisions. Conclusions: We demonstrated feasibility and the safe introduction of the Hugo RAS for RARP into an experienced robotic urological programme. Perioperative, early oncological and functional outcomes were similar to other early series. Further studies will aim to describe the learning curve with this robot and optimisation of surgical quality.

Robotic-assisted partial nephrectomy (RAPN) has become a widely used modality for the excision of renal tumours. Medtronic’s Hugo™ Robotic-Assisted Surgery (RAS) system has emerged as a promising alternative to the established Intuitive da Vinci® platform. Due to increasing use, this systematic review has been conducted to assess the safety and efficacy of the Hugo™ RAS system for RAPN. A comprehensive search was conducted to identify eligible studies that reported outcomes and experience of using the Hugo™ system for RAPN. Following appropriate screening and risk of bias assessment using ROBINS-I, results were collated into a narrative synthesis. Eight studies were included in the review. Within these, 145 patients had undergone RAPN using the Hugo™ system. These studies comprised one comparative and seven single-arm case series. Patient demographics, peri-operative outcomes, pathological outcomes and safety and feasibility parameters were extracted from the included studies. Across all these metrics, the Hugo™ system performed well. One notable finding was longer docking times compared to the da Vinci® system; however, with increasing experience and familiarity with this novel platform, this is expected to decrease. Despite the lack of high-quality evidence and few studies, the Hugo™ RAS system is a feasible option for conducting RAPN. It offered comparable and promising initial outcomes in several aspects compared to da Vinci®, alongside flexibility in docking setup. Further large-scale comparative studies are needed to corroborate the findings of this review and evaluate the longer term safety and efficacy of the Hugo™ RAS system for RAPN.