Purpose: To explore enhanced recovery after surgery (ERAS) components and their current application to major urologic surgeries, barriers to implementation and maintenance of the associated quality improvement. Data Identification: An English language literature search was done using PubMed. Study Selection: After independent review, 55 of the original 214 articles were selected to specifically address the stated purpose. Data Extraction: Clinical trials were included, randomized trials were prioritized, but robust observational studies were also included. Results of Data Synthesis: Many ERAS components have good data to support usage in radical cystectomy (RC) patients. Most ERAS programs include multidisciplinary teams carrying out multimodal pathways to hasten recovery after a major operation. ERAS components generally include preoperative counseling and medical optimization, venous thromboembolism prophylaxis, ileus prevention, avoidance of fluid overload, normothermia maintenance, early mobilization, pain control and early feeding, all leading to early discharge without increased complications or readmissions. Although there may not be specific data pertaining to other major urologic operations, the principles remain similar and ERAS is easily applicable. Conclusion: The benefits of ERAS programs are well established for RC and principles are easily applicable to other major urology operations. Barriers to implantation and maintenance of ERAS must be recognized to continue to maintain the benefits of these programs.

Purpose: The Decipher Prostate Genomic Classifier (GC) and ArteraAI Multimodal Artificial Intelligence (MMAI) platform are widely used prognostic tools for localized prostate cancer, yet no direct comparison has been performed within the same patient cohort. Experimental Design: We sought to evaluate the concordance and prognostic value of GC and MMAI across multi-institutional cohorts totaling 688 patients with localized and oligometastatic prostate cancer. These included populations enriched for African American and East Asian patients. GC and MMAI scores were stratified into risk groups based on specimen type [biopsy or radical prostatectomy (RP)]. The primary endpoint was distant metastasis–free survival, measured from diagnosis to last follow-up or event. Results: GC and MMAI scores were significantly correlated across multiple cohorts. In Moffitt RP, biopsy, and National Cancer Centre Singapore cohorts, both MMAI and GC were prognostic alone and after adjusting for clinical variables. Multivariable analysis, including both biomarkers and clinical variables, showed that MMAI was significant even when accounting for GC in Moffitt RP and borderline in Moffitt biopsy. Analysis of concordant/discordant cases showed that patients who were high risk for both GC and MMAI did qualitatively worse. In pathway analysis, concordance with GC and MMAI was high for Moffitt RP and oligometastatic patients. Across both biopsy cohorts, although most biological pathways were concordant, there were consistent discordant signaling, metabolic, and DNA repair pathways. Conclusions: In the first direct patient-level comparison of GC and MMAI in prostate cancer, these biomarkers were found to demonstrate moderate correlation, and both biomarkers demonstrated prognostic value across diverse populations and disease states.

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.