Background: Accurate staging of prostate cancer (PCa) is essential for determining the appropriate treatment and predicting outcomes. This study is comparing the effectiveness of Gallium‐68 Prostate‐Specific Membrane Antigen Positron Emission Tomography/Computed Tomography (Ga‐68 PSMA PET/CT) and multiparametric MRI (mpMRI) in preoperative locoregional staging and localizing PCa.Methods: A retrospective analysis was conducted on 78 patients who underwent both mpMRI and Ga‐68 PSMA PET/CT scans before surgery. The imaging was reviewed by radiologists and nuclear medicine specialists and compared with the final histopathology, which was reviewed by an experienced uropathologist.Results: mpMRI demonstrated higher sensitivity in detecting extraprostatic extension (EPE) and bladder neck invasion (BNI) compared to Ga‐68 PSMA PET/CT (83% vs. 44% and 29% vs. 17%, respectively). Conversely, Ga‐68 PSMA PET/CT showed higher sensitivity in detecting seminal vesicle invasion (SVI) and lymph node metastasis (LNM) (75% vs. 55% and 50% vs. 30%, respectively). When both methods were combined, sensitivity increased in detecting both EPE and SVI. The index tumor localization in mpMRI and Ga‐68 PSMA PET/CT was found to be in complete agreement with histopathological findings at 36.4% and 41.8%, respectively. When both imaging methods were combined, the agreement with histopathology in predicting index tumor localization reached 72.1%.Conclusion: Both mpMRI and Ga‐68 PSMA PET/CT provide valuable and complementary information for tumor localization and locoregional staging. While mpMRI showed higher sensitivity in detecting EPE, Ga‐68 PSMA PET/CT demonstrated superior performance in detecting LNM and SVI. The combined use of these imaging modalities enhance accuracy of index tumor localizations.

Prostate cancer (PCa) remains a leading cause of cancer-related mortality among men. Although prostate-specific antigen (PSA) is a key biomarker, its diagnostic and prognostic limitations necessitate the identification of novel markers. Urotensin-2 (UT-2), a potent vasoactive peptide, has been implicated in the pathogenesis of several malignancies, but its role in prostate cancer remains underexplored. This study aimed to evaluate plasma UT-2 levels across disease stages in PCa and assess its potential as a biomarker for metastatic disease. This cross-sectional study included 147 male patients: 100 with metastatic PCa and 47 controls (comprising benign prostatic hyperplasia [BPH], localized, and locally advanced PCa). Plasma UT-2 levels were quantified using ELISA. Statistical analyses included analysis of variance, Kruskal–Wallis, and receiver operating characteristic (ROC) curve analysis to assess UT-2’s discriminative ability and its correlation with clinical parameters such as Gleason score, ISUP grade, and PSA. UT-2 levels were significantly elevated in metastatic PCa patients (mean: 2.03 ± 0.91 ng/mL) compared to control groups (BPH: 1.42 ± 0.61 ng/mL; localized: 1.46 ± 0.71 ng/mL; locally advanced: 1.41 ± 0.76 ng/mL; P = .002). ROC analysis demonstrated a moderate discriminatory ability for metastasis (AUC = 0.70, 95% CI: 0.61–0.79), with a cutoff of 1.269 ng/mL yielding 81% sensitivity and 53% specificity. No significant associations were observed between UT-2 levels and Gleason score, ISUP grade, PSA levels, or metastatic site. This is the first clinical study to evaluate plasma UT-2 levels in PCa patients. Elevated UT-2 levels in metastatic cases, independent of traditional prognostic markers, suggest its potential utility in identifying systemic disease burden. While not suitable as a standalone diagnostic tool, UT-2 may serve as a complementary biomarker within a multiparameter panel to improve prognostication and risk stratification in PCa. Further prospective and longitudinal studies are warranted to validate its prognostic significance.

Management of recurrent prostate cancer following radiotherapy and subsequent radical prostatectomy poses considerable challenges due to potential complications for patients. Focal therapies have emerged as a burgeoning approach in prostate cancer treatment. Research indicates that ablative therapies exhibit encouraging oncological efficacy while maintaining acceptable functional outcomes in salvage interventions. Here, we present a contemporary review of focal therapy treatment modalities as well as oncologic and functional outcomes.

Focal therapy is emerging as an organ-preserving strategy for selected patients with localized prostate cancer, aiming to preserve urinary and sexual function while maintaining acceptable cancer control. However, patient and technology selection remain complex because prostate cancer is often multifocal, clinically significant lesions may be missed by imaging or biopsy, and long-term comparative oncological data are limited. This narrative review summarizes current evidence and consensus recommendations on oncological suitability, histopathological risk features, tumor burden, imaging assessment, anatomical considerations, functional priorities, and follow-up. We also discuss the complementary roles of multiparametric magnetic resonance imaging, prostate-specific membrane antigen positron emission tomography, micro-ultrasound, and artificial intelligence-assisted planning. Finally, we review how tumor location and proximity to critical structures guide selection among high-intensity focused ultrasound, cryotherapy, irreversible electroporation, transurethral ultrasound ablation, laser ablation, and photodynamic therapy. Focal therapy remains promising but requires careful selection, shared decision-making, and structured follow-up.