Prostate Cancer: Innovations in Diagnosis and Risk Stratification

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 31 December 2026 | Viewed by 739

Special Issue Editor


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Guest Editor
1. Rutgers Cancer Institute, New Brunswick, NJ, USA
2. Division of Medical Oncology, Section of Solid Tumors, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
Interests: prostate cancer; kidney cancer; testicular cancer; bladder cancer; palliative care

Special Issue Information

Dear Colleagues,

Prostate cancer management is undergoing a paradigm shift, driven by groundbreaking advances in molecular imaging and targeted therapies. The integration of Prostate Specific Membrane Antigen (PSMA)-targeted diagnostics, particularly with nuclear medicine, is revolutionizing diagnostic and therapeutic approach—from initial detection and staging to the treatment of advanced disease. This evolution is refining risk stratification, personalizing therapeutic pathways, and uncovering new challenges and opportunities.

This Special Issue of Diagnostics aims to capture the full spectrum of this transformation. We seek to explore not only the technological triumphs but also the critical nuances of modern prostate cancer care. This includes the evolving role of hormonal therapies, the pitfalls and limitations of current management strategies (from diagnostic inaccuracies to complexities in multimodal therapy), and the gaps that exist between clinical practice and established guidelines. Furthermore, we encourage submissions that address atypical presentations of the disease, which can complicate diagnosis and treatment, and contributions that discuss how novel molecular insights are bridging prostate cancer with other malignancies.

We invite researchers and clinicians to submit original research articles, comprehensive reviews, insightful case reports, and short communications on topics including, but not limited to, the following:

  • Molecular Targets in Prostate Cancer: Discovery, validation, and clinical application of new biomarkers;
  • Imaging Targets in Prostate Cancer: Discovery, validation, and clinical applications of imaging targets;
  • Overlaps in Molecular Targets in Prostate Cancer and Other Cancers: Exploring shared pathways and diagnostic/therapeutic implications;
  • Therapeutics Based on Molecular Targets: PSMA-targeted radioligand therapy, antibody-drug conjugates, and other novel agents;
  • Innovations in Diagnostics: Advanced imaging techniques, AI-assisted analysis, and liquid biopsies;
  • Refining Risk Stratification: Integrating genomic and clinical data for improved prognostication;
  • Novel Hormonal Therapy Combinations and Resistance Mechanisms;
  • Pitfalls and Challenges in Current Management: From over-diagnosis to sequencing of therapies in castration-resistant prostate cancer (CRPC);
  • Guidelines Gaps and Atypical Presentations: Case studies and analyses that challenge conventional wisdom and highlight areas for guideline evolution.

Dr. Biren Saraiya
Guest Editor

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Keywords

  • prostate cancer
  • diagnostics
  • therapeutics
  • molecular targets
  • Prostate Specific Membrane Antigen (PSMA)
  • risk stratification
  • radioligand therapy
  • multimodal therapy
  • clinical guidelines

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Published Papers (1 paper)

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Research

16 pages, 764 KB  
Article
Integrating Tumor Biology and Host Factors in mCRPC: The Prognostic Value of ‘Time to Castration Resistance’, Systemic Inflammation, and Comorbidity Burden in Patients Treated with Enzalutamide
by Seda Sali, Arife Ulaş, Sibel Oyucu Orhan, Sevgi Topçu, Muharrem Koçar, Mürsel Sali, Birol Ocak, Adem Deligönül, Türkkan Evrensel and Erdem Çubukçu
Diagnostics 2026, 16(6), 950; https://doi.org/10.3390/diagnostics16060950 - 23 Mar 2026
Viewed by 476
Abstract
Background: Outcomes with enzalutamide in metastatic castration-resistant prostate cancer (mCRPC) are influenced by tumor burden, disease kinetics, and host factors. We evaluated the relative prognostic impact of metastatic pattern, laboratory markers, and prostate-specific antigen (PSA) dynamics in a real-world cohort. Methods: We retrospectively [...] Read more.
Background: Outcomes with enzalutamide in metastatic castration-resistant prostate cancer (mCRPC) are influenced by tumor burden, disease kinetics, and host factors. We evaluated the relative prognostic impact of metastatic pattern, laboratory markers, and prostate-specific antigen (PSA) dynamics in a real-world cohort. Methods: We retrospectively analyzed 72 patients with mCRPC treated with enzalutamide. Progression-Free Survival (PFS) and Overall Survival (OS) were estimated using the Kaplan–Meier method. Multivariate Cox proportional hazards models were utilized to identify independent predictors of survival, incorporating clinical variables (visceral metastases, bone tumor burden), kinetic parameters (Time to Castration Resistance [TTCR], Time to PSA Nadir [TTN]), and host factors (Charlson Comorbidity Index [CCI], Eastern Cooperative Oncology Group Performance Status (ECOG PS), Systemic Immune-Inflammation Index [SII], HALP score). Results: Visceral metastasis was a dominant predictor of poor outcomes, increasing the risk of death by 4.0-fold (HR: 4.05; 95% CI: 1.84–8.89; p < 0.001). A high skeletal tumor burden (≥5 bone lesions) was identified as a critical threshold, associated with a 5.5-fold increase in mortality risk (HR: 5.53; p < 0.001). Delays in initiating enzalutamide significantly compromised survival, with each 1-month delay increasing the risk of death by 7.3% (HR: 1.07; p = 0.003). While early PSA decline (≥50% at 3 months) did not independently predict OS, a prolonged TTN (>12 months) was associated with superior survival. Notably, host-related factors, including age, CCI, and ECOG PS, were not found to be significantly associated with survival outcomes in this specific dataset. Conclusions: Our preliminary findings suggest that survival in real-world mCRPC patients treated with enzalutamide may be influenced predominantly by intrinsic tumor biology—specifically anatomical extent and resistance kinetics—rather than host frailty or comorbidity burden. However, given the retrospective and single-center nature of this study, these findings should be considered hypothesis-generating and require validation in larger, multi-center cohorts. Host-related variables (including age and CCI) were evaluated but were not retained as independent predictors in the final multivariable model. Early initiation of therapy and monitoring of kinetic markers like TTN and TTCR offer superior prognostic stratification compared to static baseline characteristics. Full article
(This article belongs to the Special Issue Prostate Cancer: Innovations in Diagnosis and Risk Stratification)
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