Prostate cancer diagnostics have evolved substantially with the integration of multiparametric magnetic resonance imaging (mpMRI), refined prostate-specific antigen (PSA) metrics, and targeted biopsy techniques. While mpMRI has become a central gatekeeper in biopsy decision-making, it is not infallible. Clinically significant prostate cancer may therefore remain undetected, particularly in patients with elevated PSA density, adverse PSA kinetics, or MRI-occult disease. This narrative review synthesizes contemporary evidence on PSA interpretation, mpMRI performance, and biopsy strategy selection, highlighting the limitations of single-parameter approaches. We discuss the diagnostic yield and clinical implications of targeted, systematic, and combined biopsy techniques, emphasizing scenarios in which systematic sampling remains necessary despite negative or equivocal imaging findings. Emerging data support combined targeted and systematic biopsy as the most robust strategy for maximizing the detection of clinically significant disease while limiting overdiagnosis in most biopsy-naive and high-risk patients. By integrating PSA dynamics, prostate volume, imaging findings, and individual risk profiles, a structured, risk-adapted diagnostic pathway can be achieved. The proposed framework is intended as a conceptual, expert-derived clinical aid to support risk-adapted decision-making. It should be interpreted alongside established guidelines, and prospective validation in future studies is warranted.

Background: The COVID-19 pandemic profoundly disrupted healthcare systems worldwide, raising concerns regarding delays in cancer diagnosis and treatment. How these disruptions affected breast cancer care during and after the pandemic remains incompletely understood, particularly in Eastern European oncology centers. Methods: We conducted a retrospective cohort study of breast cancer patients treated at the Oncological Institute of Bucharest, comparing a pandemic cohort (n = 73) with a post-pandemic cohort (n = 99) regarding age at diagnose, tumor laterality, tumor location, tumor stage, and time intervals across the diagnostic and treatment pathways. We measured the intervals between: GP referral and the patien’s first presentation to the surgery unit; imaging diagnosis; the date of biopsy or surgery, biopsy result, and initiation of neoadjuvant treatement; the end of neoadjuvant treatement and surgery; surgery and adjuvant treatment; and the interval of time between chemotherapy sessions. Results: Between the two cohorts, the median age was similar (56 [47–67] vs. 59 [50–68] years). Similarities were also found in tumor laterality and quadrant location. In the post-pandemic cohort, 31.3% of patients were diagnosed with advanced stages, compared with 20.5% in the pandemic cohort, although this difference did not reach statistical significance. Our study showed that chemotherapy delivery was more efficient post-pandemic, with shorter intervals between treatment sessions (18 [17–19] vs. 21 [21–22] days). Referral-to-presentation times were also shorter post-pandemic (3 [1–8] vs. 6 [2–10] days). In contrast, during the post-pandemic year, the interval between the end of neoadjuvant therapy and surgery, remained prolonged. Conclusions: During the COVID-19 pandemic, breast cancer care at a major oncology Romanian center was preserved through adapted clinical pathways. We also established that delays in surgical treatment happened in the post-pandemic period and a higher percentage of advanced-stage disease cases were diagnosed. Our findings may suggest that pre-hospital delays and residual system constraints contributed to stage migration in the post-pandemic group rather than deficiencies in oncology care.

Boerhaave syndrome, or spontaneous rupture of the esophageal wall, is a rare condition that occurs after a violent increase in intraesophageal pressure associated with negative intrathoracic pressure after forceful vomiting or retching. Rupture, usually transmural, often occurs in the distal esophagus and can be complicated by mediastinitis, sepsis, and multiple organ dysfunction. Despite the aid of imaging in diagnosis and rapid management, it is still characterized by a high mortality rate. Surgical and endoscopic approaches are the mainstays of treatment. Case presentation: Here, we describe three cases of Boerhaave’s syndrome managed with minimally invasive surgical treatment and provide a brief literature review of the treatment methods for this rare condition. Conclusions: Early diagnosis and prompt management by a multidisciplinary team increase the chances of survival. The laparoscopic approach is beneficial and can successfully treat esophageal tears associated with this syndrome in early or delayed timing.