Introduction: Radiotracer-based nuclear imaging, including positron emission tomography (PET) and single-photon emission computed tomography (SPECT), can complement conventional cross-sectional imaging in renal cell carcinoma (RCC) by providing biological characterisation of tumour metabolism, angiogenesis, hypoxia, and the tumour microenvironment. While computed tomography (CT) and magnetic resonance imaging (MRI) remain the diagnostic standard, accumulating evidence suggests that selected nuclear imaging techniques may offer incremental value in specific clinical scenarios. Methods: A narrative literature review was performed using PubMed, Embase, and Web of Science to identify preclinical, retrospective, and prospective studies evaluating PET and SPECT radiotracers in localised and metastatic RCC. Priority was given to meta-analyses, multicentre prospective trials, and studies with histopathological correlation. Results: [¹⁸F]fluorodeoxyglucose (FDG) PET/CT demonstrates limited sensitivity for primary renal tumours (pooled sensitivity of approximately 60%) but performs substantially better in metastatic and recurrent disease (pooled sensitivity and specificity of approximately 85–90%), where uptake correlates with tumour grade, progression-free survival, and overall survival. [^99mTc]sestamibi SPECT/CT differentiates oncocytoma and hybrid oncocytic/chromophobe tumours from malignant RCC with pooled sensitivity and specificity of around 85–90%, supporting its role in evaluating indeterminate renal masses rather than staging. Prostate-specific membrane antigen (PSMA) PET/CT shows high detection rates in clear-cell RCC, particularly in metastatic disease, with reported sensitivities of approximately 85–90% and management changes in up to 40–50% of selected cohorts. Carbonic anhydrase IX (CAIX)-targeted PET/CT enables the biologically specific visualisation of clear-cell RCC, achieving sensitivities and specificities in the range of 85–90% in prospective phase II and III trials for primary tumour characterisation. Fibroblast activation protein inhibitor (FAPI) PET/CT demonstrates high tumour-to-background uptake in early RCC studies, but evidence remains preliminary, with small cohorts and recognised non-specific uptake in benign inflammatory and fibrotic conditions. Conclusions: Radiotracer-based nuclear imaging provides complementary, biology-driven insights in RCC that extend beyond anatomical assessment. While most modalities remain adjunctive or investigational and are not recommended for routine use, selective application in carefully chosen clinical scenarios may enhance tumour characterisation, prognostication, and personalised treatment planning.

High-risk and locally advanced prostate cancer represents 20–25% of new diagnoses of prostate cancer and is associated with high rates of recurrence, morbidity, and mortality. The neoadjuvant window provides a unique opportunity for systemic control prior to definitive therapy with radical prostatectomy or radiotherapy (RT). Early trials with first-generation androgen deprivation therapy (ADT) achieved pathological downstaging but no survival benefit. In the 2000s, the advent of chemohormonal regimes using docetaxel provided excitement but mixed results tempered expectations and is now not recommended prior to surgery. Second-generation androgen receptor pathway inhibitors (ARPIs) combined with ADT have demonstrated significant survival benefit in metastatic prostate cancer and are currently being evaluated in large phase III trials in the neoadjuvant setting. RT remains an alternative curative modality, and recent data highlights similar issues to surgery in eradicating micrometastatic disease despite excellent local control. This has driven parallel efforts to evaluate intensified systemic therapy in the pre-RT/neoadjuvant settings. In addition to the excitement surrounding ARPIs, radioligand therapy, such as [¹⁷⁷Lu]Lu-PSMA-617 has shown promise in the neoadjuvant setting and continues to be investigated. Future research aims to incorporate genomic and molecular factors to enable personalised neoadjuvant therapies by identifying damage immunologically responsive subtypes that may derive greater benefit from immune-directed therapies in the peri-operative setting. This narrative review synthesises current evidence for neoadjuvant therapies in high-risk prostate cancer and future directions.

Introduction: PI-RADS 3 lesions represent a diagnostic grey zone on multiparametric MRI, with clinically significant prostate cancer (csPCa) detected in only 10–30%. Their equivocal nature leads to both unnecessary biopsies and missed cancers. Artificial intelligence (AI) has emerged as a potential tool to provide objective, reproducible risk prediction. This review summarises current evidence on AI for risk stratification in patients with indeterminate mpMRI findings, including clarification of key multicentre initiatives such as the PI-CAI (Prostate Imaging–Artificial Intelligence) study—a global benchmarking effort comparing AI systems against expert radiologists. Methods: A narrative review of PubMed and Embase (search updated to August 2025) was conducted using terms including “PI-RADS 3”, “radiomics”, “machine learning”, “deep learning”, and “artificial intelligence.” Eligible studies included those evaluating AI-based prediction of csPCa in PI-RADS 3 lesions using biopsy or long-term follow-up as reference standards. Both single-centre and multicentre studies were included, with emphasis on externally validated models. Results: Radiomics studies demonstrate that handcrafted features extracted from T2-weighted and diffusion-weighted imaging can distinguish benign tissue from csPCa, particularly in the transition zone, with area-under-the-ROC curves typically 0.75–0.82. Deep learning approaches—including convolutional neural networks and large-scale representation-learning frameworks—achieve higher performance and can reduce benign biopsy rates by 30–40%. Models that integrate imaging-based AI with clinical predictors such as PSA density further improve discrimination. The PI-CAI study, the largest international benchmark to date (>10,000 MRI exams), shows that state-of-the-art AI systems can match or exceed expert radiologists for csPCa detection across diverse scanners, centres, and populations, though prospective validation remains limited. Conclusions: AI shows strong potential to refine management of PI-RADS 3 lesions by reducing unnecessary biopsies, improving csPCa detection, and mitigating inter-reader variability. Translation into routine practice will require prospective multicentre validation, harmonised imaging protocols, and integration of AI outputs into clinical workflows with clear thresholds, decision support, and safety-net recommendations.

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.