Objective: To provide a comprehensive review and analysis of guidelines from various professional and medical organisations regarding the use of prostate‐specific membrane antigen (PSMA) positron emission tomography (PET) as a staging scan for men with newly diagnosed intermediate‐risk prostate cancer (PCa).Materials and Methods: English‐language guidelines and recommendations from the following associations and societies were reviewed and critically analysed: European Association of Urology (EAU), American Urological Association (AUA), National Comprehensive Cancer Network (NCCN), National Institute for Health and Care Excellence (NICE), Canadian Urological Association (CUA), American Society for Clinical Oncology (ASCO), Society for Nuclear Medicine and Medical Imaging (SNMMI).Results: There is significant disagreement among guidelines regarding whether PSMA PET is a useful staging tool for men with a new diagnosis of intermediate‐risk PCa. There is a stronger consensus that PSMA PET is useful in staging high‐risk PCa.Conclusion: Whilst there is a growing body of evidence that supports the use of PSMA PET in newly diagnosed PCa, there is significant disagreement regarding its use for men with intermediate‐risk disease. Recommendations are generally weak and based on expert opinions. This is an area of considerable ongoing research, and guidelines are likely to change as new evidence emerges.

Active surveillance remains the preferred treatment for men with low-risk prostate cancer and select men with favourable intermediate-risk prostate cancer. It involves the close observation of clinicopathological parameters to assess for disease progression, aiming to delay or avoid definitive treatment and related toxicities for as long as possible, without compromising oncological outcomes. A recent advancement in prostate cancer staging is the PSMA PET scan, which uses a tracer that strongly binds a highly expressed cellular biomarker for prostate cancer. Recent articles have also demonstrated that PSMA PET may be a useful tool for risk-stratifying prostate cancer, with the SUVMax of the scan correlated with higher-grade prostate cancer. This has ignited interest in the potential use of PSMA PET to identify men with higher-risk prostate cancer who may be unsuitable for active surveillance, particularly those who were incorrectly classified as lower risk upon initial diagnosis. This review article aims to assess the current state of the literature and clinical guidelines regarding the use of PSMA PET as a tool to risk-stratify prostate cancer, and whether it can be incorporated into active surveillance protocols to identify men who were incorrectly risk-stratified at time of initial diagnosis.

Objective: To provide a comprehensive review, analysis and critique of guidelines from various oncological and urological organisations regarding the use pelvic lymph node dissection (PLND) in men undergoing radical prostatectomy (RP) for primary treatment of prostate cancer (PCa). Methods: PubMed, Google Scholar and the official webpages of major urological and oncological societies were searched for PCa guidelines. Guidelines were assessed for recommendations and opinions regarding the use of PLND. A total of 15 guidelines were identified and included for this review. Results: There is consensus amongst guidelines that an extended template (ePLND), is the preferred templated when PLND is to be undertaken. The majority of guidelines acknowledge the lack of proven oncological benefit from PLND, and that the largest benefit is from improved staging information. However, there is significant divergence between the guidelines about which patients should undergo PLND. Some guidelines advocate for the abandonment of PLND altogether, whilst others adopt a risk‐stratified approach, suggesting that patients should be offered PLND based on nomograms or clinical risk stratification. Conclusion: Whilst ePLND is recommended by some guidelines for select patients undergoing RP, it remains a contentious topic with significant discordance between guidelines regarding patient selection. Given the lack of proven oncological benefit and significant morbidity from the procedure, careful selection is required. It is uncertain as to how pathological findings on PLND will change management given recent trends towards salvage rather than adjuvant radiotherapy, and improved preoperative staging with prostate‐specific membrane antigen‐positron emission tomography/computed tomography.

Background: Small renal masses (SRMs) are increasingly prevalent. Percutaneous renal biopsy (PRB) is usually reserved for diagnosis of benign renal disease or secondary metastatic disease. SRMs are frequently benign or of low malignant potential. Invasive treatment may result in significant morbidity. Current literature supports the use of PRB in diagnostic assessment of SRMs. We aim to assess the rates of PRB in Australia since its introduction in the Medicare Benefits Scheme (MBS). Methods: Data regarding PRBs for the period between January 2000 and December 2024 were extracted from the MBS. Paediatric patients aged <15 years were excluded. Population-adjusted incidences were calculated using publicly available demographic data. Results: A total of 31,870 PRBs were performed between 2000 and 2024, with an average year-on-year increase of 0.24 PRBs per 100,000 persons per year (95% CI: 0.21–0.27) and an absolute increase of 4.9 PRBs per 100,000 persons. Males had higher PRB rates than females (mean difference: 2.73 per 100,000/year). The largest rise was in NSW, increasing by 13.6 per 100,000, with similar increases in VIC and QLD (4.9 and 2.8 per 100,000, respectively). SA, TAS, and ACT experienced significant reductions (5.7, 3.5, and 6.0 per 100,000, respectively). There was significant inter-state heterogeneity (p < 0.001). PRB rates were highest among the 55–74 and ≥75 age groups. The PRB:nephrectomy ratio increased significantly (0.02/year; 95% CI: 0.016–0.024). Conclusions: The consensus supporting PRBs for SRMs is reflected in Australia. However, there remains significant heterogeneity between demographic groups. Further work is necessary to ensure standard-of-care treatment accessibility to prevent overtreatment.