Cancer stem cells (CSCs) are a small and elusive subpopulation of self-renewing cancer cells with the remarkable ability to initiate, propagate, and spread malignant disease. In the past years, several authors have focused on the possible role of CSCs in PCa development and progression. PCa CSCs typically originate from a luminal prostate cell. Three main pathways are involved in the CSC development, including the Wnt, Sonic Hedgehog, and Notch signaling pathways. Studies have observed an important role for epithelial mesenchymal transition in this process as well as for some specific miRNA. These studies led to the development of studies targeting these specific pathways to improve the management of PCa development and progression. CSCs in prostate cancer represent an actual and promising field of research.

Post-operative acute kidney injury (PO-AKI) is a serious complication that may occur after major abdominal surgery. The administration of intravenous perioperative amino acids (AAs) has been proven to increase kidney function and has some beneficial effects to prevent PO-AKI. The aim of this study was to establish if the perioperative infusion of AAs may reduce the incidence of PO-AKI in patients undergoing major urological minimally invasive surgery. From a total of 331 patients, the first 169 received perioperative crystalloid fluids and the following 162 received perioperative AA infusions. PO-AKIs were much higher in the crystalloid group compared to the AA group (34 vs. 17, p = 0.022) due to a lower incidence of KDIGO I and II in the AA group (14 vs. 30 p = 0.016). The AA group patients who developed a PO-AKI presented more risk factors compared to those who did not (2 (2-4) vs. 1 (1-2), p = 0.031) with a cut-off of 3 risk factors in the ROC curve (p = 0.007, sensitivity 47%, specificity 83%). The hospital length of stay was higher in the crystalloid group (p < 0.05) with a consequent saving in hospital costs. Perioperative AA infusion may help reduce the incidence of PO-AKI after major urological minimally invasive surgery.

Introduction: In recent years, due to the increasing life expectancy and the growing popularity of nephron sparing strategies (NSS), more elderly and frail patients are undergoing Robotic-Assisted Partial Nephrectomy (RAPN) for the treatment of localized Renal Cell Carcinoma (RCC). A Single Port Approach has demonstrated itself to reduce estimated blood loss (EBL), complication rates, and length of stay (LOS). In the present study, we aim to compare perioperative and postoperative outcomes of SP RAPN and Multi Port (MP) RAPN, with a focus on elderly patients. Materials and Methods: In the study, 293 cN0M0 RCC patients who underwent MP and SP RAPN performed at our institution from 2018 to 2024 were retrospectively reviewed. Clinical, demographic, patient, and tumor characteristics and perioperative variables were assessed across group A (<65 years old) and group B (≥65 years old) patients, as well as MP and SP cohorts. Subsequently, univariate and multivariate regression analyses were carried out, particularly for elderly patients, to evaluate the impact of selected preoperative and perioperative variables on the risk of 30-day postoperative complications. Results: Clinical and demographic characteristics were similar across the MP and SP cohorts of group A and group B. The SP cohort of both group A and group B demonstrated significantly higher rates of extraperitoneal access (75.9% vs. 26.6% for group A, p < 0.001 and 81.8% vs. 26.2% for group B, p < 0.001), shorter median operative times (186 [142.8–222] min vs. 190 [153–238] min for group A, p < 0.001 and 173.5 [143–228] min vs. 206 [178–237] min for group B, p < 0.001), and shorter median LOS (0 [0–1] days vs. 2 [1–3] days for group A, p < 0.001 and 0 [0,1] days vs. 2 [2–4] days for group B, p < 0.001). Moreover, for both groups, an SP approach required significantly longer median ischemia times (21 min [18–31] vs. 20 min [16–24] for group A, p = 0.02 and 24.5 min [20–28] vs. 19.5 min [16–26] for group B, p = 0.03). However, the SP cohort of group B, despite the lower rate of on-clamp procedures (63.4% vs. 90.5%, p = 0.03), demonstrated significantly lower median EBL (50 mL [31–142] vs. 100 mL [50–200], p = 0.03). At multivariate analysis, the SP approach was an independent predictor of lower 30-day postoperative complications (OR: 0.2, 95%CI 0.04–0.9, p = 0.04). Conclusions: In the present study, elderly patients undergoing SP RAPN did not demonstrate higher complication rates, EBL or hospitalization days compared to their younger counterparts. Moreover, an SP approach was found protective for 30-day postoperative complications. Our results suggest that SP RAPN is feasible and safe in older and frailer patients.

Purpose: The accuracy of multiparametric magnetic resonance imaging (mpMRI) heavily relies on image quality, as evidenced by the evolution of the prostate imaging quality (PI-QUAL) scoring system for the evaluation of clinically significant prostate cancer (csPC). This study aims to evaluate the impact of PI-QUAL scores in detecting csPC within PI-RADS 4 and 5 lesions. Methods: We retrospectively selected from our database all mpMRI performed from January 2019 to March 2022. Inclusion criteria were as follows: (1) mpMRI acquired in our institution according to the technical requirements from the PI-RADS (v2.1) guidelines; (2) single lesion scored as PI-RADS (v2.1) 4 or 5; (3) MRI-TBx performed in our institution; (4) complete histology report; and (5) complete clinical record. Results: A total of 257 male patients, mean age 70.42 ± 7.6 years, with a single PI-RADS 4 or 5 lesion undergoing MRI-targeted biopsy, were retrospectively studied. Of these, 61.5% were PI-RADS 4, and 38.5% were PI-RADS 5, with 84% confirming neoplastic cells. In high-quality image lesions (PI-QUAL ≥ 4), all PI-RADS 5 lesions were accurately identified as positive at the final histological examination (100% of CDR). For PI-RADS 4 lesions, 37 (23%) were negative, resulting in a cancer detection rate of 77% (95% CI: 67.51–84.83). Conclusions: The accuracy of mpMRI, independently of the PI-RADS score, progressively decreased according to the decreasing PI-QUAL score. These findings emphasize the crucial role of the PI-QUAL scoring system in evaluating PI-RADS 4 and 5 lesions, influencing mpMRI accuracy.

Background/Objectives: Single-port radical prostatectomy (SP-RARP) has been demonstrated to be a feasible and safe procedure, even in older patients. This study aims to compare multi-port radical prostatectomy (MP-RARP) with SP-RARP, with a particular focus on elderly patients. Methods: Patients who underwent SP-RARP or MP-RARP between January 2018 and December 2023 were retrospectively analyzed. Patients undergoing concomitant surgical procedures or diagnosed with locally advanced prostate cancer were excluded from this study. Patients were then stratified into two groups: Group A (age < 65 years) and Group B (age ≥ 65 years). Results: A total of 338 patients (153 MP-RARP and 185 SP-RARP) were retrospectively collected. In Group B, the length of stay (in hours) was significantly shorter for SP procedures compared to MP (18 (20.8) vs. 35 (17); p = 0.002), with a higher rate of same-day discharge in favor of SP (45 (54.9%) vs. 9 (16.7%); p < 0.001). Additionally, MP patients in Group B had a higher incidence of postoperative complications at both 30 days (19(35.2%) vs. 13 days (15.9%); p = 0.009) and 90 days (21(38.9%) vs. 14 days (17.1%); p = 0.004) compared to those undergoing SP. Multivariable logistic regression analysis identified SP as a protective factor against postoperative complications at 30 days (Odds ratio: 0.41; 95% CI: 0.15, 0.97; p value = 0.027) and 90 days (Odds ratio: 0.38; 95% CI: 0.17,0.788; p = 0.024). Additionally, length of stay was associated with postoperative complications at 30 days (Odds ratio: 1.02; 95% CI: 1.01, 1.13; p value = 0.046). Conclusions: SP-RARP is a safe and feasible option for elderly patients, offering a lower incidence of short-term postoperative complications compared to MP-RARP. Furthermore, same-day discharge is feasible even in elderly patients undergoing SP-RARP.