Search Results (334)

Diisononyl cyclohexane-1,2-dicarboxylate (DINCH), a non-phthalate plasticizer adopted as a safer alternative for food-contact and medical-grade materials, is ubiquitously detected in human biomonitoring studies. Despite widespread exposure, its transcriptional effects in prostate cells and the potential prostate cancer relevance of DINCH-responsive genes remain unclear. We integrated transcriptomic profiling of DINCH-exposed human prostate epithelial cells with exploratory genetic association analyses in 630 patients with prostate cancer receiving androgen deprivation therapy (ADT). Haplotype-tagged single-nucleotide polymorphisms (SNPs) in candidate DINCH-responsive genes were evaluated for their association with overall survival (OS) and cancer-specific survival (CSS). The prostate cancer relevance of the prioritized genes was further validated using pooled multi-cohort bioinformatic analyses. DINCH exposure produced an exploratory molecular signature comprising 83 genes across all tested doses, broadly suppressing cell–matrix adhesion pathways and activating chromatin remodeling. Exploratory genetic screening identified nominal associations of LPP rs1040033 with OS (p = 0.0002, q = 0.131) and FAM111B rs7110278 with CSS (p = 0.0010, q = 0.575); neither association remained significant after multiple-testing correction. DINCH exposure significantly downregulated LPP and upregulated FAM111B expression in prostate epithelial cells. Independently, pooled analyses demonstrated reduced LPP and elevated FAM111B expression in prostate cancer tissues compared with normal prostate tissues. Higher LPP expression predicted a favorable prognosis, whereas elevated FAM111B predicted worse survival. Pathway analyses linked low LPP expression to impaired adhesion signaling and metabolic reprogramming, whereas high FAM111B expression was associated with mitotic and cell-cycle activation. DINCH exposure induced exploratory transcriptional alterations involving LPP-related adhesion pathways and FAM111B-related proliferative signaling. The genetic findings are exploratory and require independent validation. Although public datasets support the prognostic relevance of LPP and FAM111B in prostate cancer, they do not link these genes to DINCH exposure. Full article

Background/Objectives: Perioperative androgen-deprivation therapy (ADT) and androgen-receptor pathway inhibitors (ARPIs) are increasingly used in high-risk prostate cancer, yet patient-centred functional-recovery data after radical prostatectomy are scarce and rarely standardized. We assessed whether a smartphone-based digital monitoring pathway could characterize social-continence recovery and capture differences associated with a perioperative hormonal therapy (PHT) strategy after robot-assisted radical prostatectomy with pelvic lymph-node dissection (RARP + LND). Methods: In a two-centre consecutive cohort (n = 98) of men with high-risk, non-metastatic prostate cancer aligned with SUGAR and PROTEUS criteria, we compared upfront surgery (standard of care [SOC], n = 72) with a planned PHT strategy (ADT or ARPI, n = 26); all patients were urinary-continent preoperatively. Clinical data were prospective; patient-reported and patient-experience measures were captured through a routine-care digital platform (Betty Coaching application) delivering an identical prehabilitation/rehabilitation pathway to both groups, with pre- and postoperative pelvic-floor muscle training performed by all patients. The primary endpoint was 6-month social continence (0–1 pad/day), assessed by clinician and patient reports as co-primary sources. Differences are reported as risk differences with 95% confidence intervals (CIs). Results: At 6 weeks, no statistically clear difference was observed (clinician 66.2% vs. 56.5%; risk difference 9.7 percentage points, 95% CI −12 to 32). At 6 months, social continence was lower with PHT (clinician 87.1% vs. 65.0%, difference 22.1 points, 95% CI 2.6 to 44.7; patient 81.3% vs. 58.3%, 22.9 points, 95% CI 2.4 to 43.9), converging by 12 months (96.9% vs. 95.0%). Analgesic-free rates were lower with PHT on postoperative days (POD) 7 and 10. Conclusions: Digital monitoring captured granular recovery trajectories and identified a mid-term social-continence signal associated with PHT, compatible with a transient delay in recovery. These hypothesis-generating findings support embedding standardized digital functional-outcome monitoring in perioperative trials. Full article

Background/Objectives: High-risk prostate cancer is a biologically heterogeneous group of tumors carrying a substantial risk of progression to lethal, castration-resistant disease. Although androgen deprivation therapy (ADT) remains the therapeutic backbone, nearly all advanced disease eventually progresses to castration-resistant prostate cancer (CRPC) through Darwinian clonal evolution under sustained therapeutic pressure. This narrative review reframes high-risk prostate cancer management as an effort to reprogram the evolutionary trajectory and delay castration resistance, addressing current risk stratification, androgen receptor (AR)-dependent and AR-independent mechanisms of resistance, and multidisciplinary strategies that modify selective pressure. Methods: A narrative review of the literature was conducted, including peer-reviewed studies, pivotal phase III trial reports, and current clinical practice guidelines indexed in PubMed, Scopus, and Web of Science up to 2026. Sources on high-risk and castration-resistant prostate cancer, the biology of treatment resistance, and multidisciplinary treatment intensification were selected and synthesized. Results: Treatment intensification has been extended to high-risk biochemical recurrence (EMBARK), directed by biomarkers in PTEN-deficient disease (CAPItello-281), and moved earlier through prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (PSMAfore, PSMAddition). In localized disease, effective AR-pathway intensification with abiraterone (STAMPEDE) contrasts with the failure of chemotherapy (PEACE-2) and enzalutamide (ENZARAD). Emerging therapies targeting lineage plasticity exploit its dynamic and potentially reversible biology, raising the prospect of reversing established resistance rather than merely delaying it. CAPItello-281 and PSMAddition have immature overall survival data and are not yet standard of care. Conclusions: Coordinated multidisciplinary care, matched to the disease stage and molecular context, offers a realistic path to delay castration resistance and improve survival. Full article

Background: Blood-accessible biomarkers may support future personalization of prostate cancer radiotherapy, but their interpretation depends on sampling timing relative to radiotherapy, androgen deprivation therapy, and post-treatment recovery. We mapped clinical evidence for selected biomarker domains beyond prostate-specific antigen: γ-H2AX/DNA damage response, IL-6/inflammatory mediators, testosterone/endocrine recovery and a prespecified galectin-1/3 immune–stromal domain evaluated as a potential evidence gap. Methods: We conducted a PRISMA-ScR scoping review of PubMed, Scopus, and Web of Science searched on 7 January 2026. Eligible original human studies evaluated soluble serum/plasma analytes or peripheral blood cell-based assays in prostate RT pathways. Data were charted by biomarker domain, treatment context, RT modality/fractionation, assay reporting, sampling schedule, and endpoint linkage. Results: Of 3499 records, 45 studies were included. No eligible study reported repeated circulating galectin-1/3 kinetics anchored to prostate radiotherapy, identifying a distinct clinical evidence gap. The remaining evidence was dominated by testosterone studies (n = 28), followed by IL-6/inflammatory mediators (n = 12) and γ-H2AX/DDR (n = 5). Testosterone studies were mapped as separate RT-only endocrine kinetics and ADT-anchored recovery streams. IL-6 studies mainly used during-RT or early post-RT sampling and linked trajectories to acute toxicity, fatigue, symptoms or inflammatory phenotypes; no included study directly validated serial IL-6/inflammatory trajectories against biochemical control, metastasis-free survival, or overall survival. γ-H2AX studies were characterized by ultra-acute, fraction-anchored sampling. Across domains, baseline definition and sampling timing limited interpretability more than assay platform alone. Conclusions: Evidence maturity was unequal across the selected domains. Testosterone provided the comparatively more developed longitudinal clinical literature, whereas IL-6/inflammatory mediators remained exploratory and were linked mainly to acute toxicity, fatigue, symptoms, and inflammatory phenotypes. γ-H2AX remained predominantly a translational and biodosimetry-oriented marker, while galectin-1/3 represented a hypothesis-generating clinical evidence gap. None of these biomarkers currently supports routine biomarker-guided prostate RT personalization. Future biomarker-embedded studies may benefit from domain-specific sampling considerations, explicit RT/systemic-therapy context stratification, standardized assay reporting, and clinically relevant endpoints. Full article

Physical activity (PA) can provide protective benefits for prostate cancer (PCa) survivors. Healthcare practitioners are ideally positioned to promote PA to their PCa patients. This study was designed to identify how practitioners have advised and supported their PCa patients to try and overcome barriers to PA. A secondary aim was to identify if there were differences in the types of PA advice provided based on practitioner specialty and number of years in practice. Participants were 13 healthcare practitioners from Auckland, New Zealand, who provide biomedical (urology, oncology) and allied health services (physiotherapy) to men who have received a diagnosis of PCa. Participants were individually interviewed and data were analyzed using an inducive thematic approach. Three main themes and four sub-themes were identified. Physical activity advice did not appear to differ based on practitioner specialty or length of time in practice; rather, PA advice was provided to help counteract the associated side effects of specific PCa treatments. Verbal information, encouragement and resources were provided to help support PA. Specialist cancer nurses can provide long-term PA advice and support. Individualized exercise programs through physiotherapy can benefit men receiving active PCa treatment, as well as men in remission experiencing treatment-related side effects. Full article

Background/Objectives: Prostate cancer is one of the most common malignancies among men worldwide, and clinical outcomes following androgen deprivation therapy (ADT) vary considerably. Given that endoplasmic reticulum (ER) stress and the unfolded protein response mediate processes such as apoptosis, tumor adaptation, and disease progression, we aimed to investigate whether genetic variants in ER stress-related genes are associated with survival outcomes in patients with prostate cancer receiving ADT. Methods: This study enrolled 630 patients with prostate cancer who underwent ADT across three medical centers in Taiwan. A genetic association analysis of 89 haplotype-tagged single-nucleotide polymorphisms (SNPs) across 12 ER stress-related genes was performed. The primary clinical endpoint was overall survival (OS). Kaplan–Meier survival analysis and Cox proportional hazards models were used to evaluate prognostic associations. Furthermore, publicly available databases were integrated to analyze gene expression, clinical relevance, gene set enrichment, and tumor immune infiltration to elucidate the underlying biological mechanisms. Results: Among the analyzed SNPs, BAX rs182509214 showed the strongest association with OS. The minor G allele of BAX rs182509214 was significantly associated with poorer OS. Prostate tumor tissues exhibited markedly elevated BAX expression compared with normal prostate tissues, and this elevated expression was associated with worse survival outcomes. Multiple public gene expression datasets confirmed the overexpression of BAX in prostate cancer. Functional analyses revealed that genes associated with BAX expression were predominantly enriched in ribosomal, oxidative phosphorylation, and proteasomal pathways. Furthermore, the BAX copy number variation was significantly associated with the infiltration levels of multiple immune cell types, and BAX expression was negatively correlated with CD8⁺ T-cell infiltration, implying a potential marker role for the tumor immune microenvironment. Conclusions: The ER stress-related genetic variant, BAX rs182509214, may influence survival outcomes in patients with prostate cancer receiving ADT. BAX alterations are associated with disease progression and linked to mitochondria-related metabolic pathways and the tumor immune microenvironment. These results highlight BAX as a potential prognostic biomarker for prostate cancer treated with ADT; however, further validation in larger cohorts and functional studies is warranted. Full article

The prognostic significance of next-generation sequencing (NGS) findings during the hormone-sensitive phase of prostate cancer remains incompletely characterized. This retrospective cohort study included 92 patients who underwent NGS analysis on tumor tissue between 2019 and 2025. The primary endpoint was time to castration-resistant prostate cancer (CRPC) from androgen deprivation therapy (ADT) initiation; secondary endpoints were overall survival from ADT initiation (OS-ADT) and from diagnosis. Kaplan-Meier and Cox regression analyses were performed. CRPC developed in 66 patients (71.7%) at a median of 21.1 months. The most frequently altered genes were ATR (35.9%), PTEN (28.3%), TP53 (26.1%), and BRCA2 (15.2%). KMT2C alteration (5.4%) was the strongest independent genomic predictor of shorter time to CRPC (HR = 6.804, p = 0.003) and OS-ADT (HR = 4.730, p = 0.019). TP53 alteration independently predicted shorter OS-ADT (HR = 1.810, p = 0.038). High genomic burden independently predicted shorter time to CRPC (HR = 1.917, p = 0.032). Homologous recombination repair deficiency was not associated with outcomes, attributable to high ATR alteration frequency introducing pathway heterogeneity. Mismatch repair deficiency showed a borderline association with shorter OS-ADT (20.7 vs. 44.0 months; p = 0.060). An exploratory composite risk score stratified patients into three prognostic groups with markedly different outcomes (HR = 7.904, p = 0.001). NGS analysis during the hormone-sensitive phase identifies independent predictors of castration resistance, supporting its integration at ADT initiation for risk stratification and biomarker-guided treatment planning. Full article

Background: High-risk (HR) prostate cancer has a propensity for local and distant progression with ultimate death, mandating aggressive locoregional and systemic treatment approaches to maximize oncologic outcomes. Although brachytherapy (BT) with supplemental therapies has demonstrated favorable biochemical and quality of life outcomes, improvements in overall survival have been hampered by an excessive incidence of non- prostate cancer deaths. In this HR study, we report on biochemical failure (BF), prostate cancer-specific mortality (PCSM), overall mortality (OM) and patterns of death with recommendations for the mitigation of non-prostate cancer deaths. Materials and Methods: From April 1995 to November 2018, 577 consecutive HR patients were treated with LDR BT (97.9% Pd-103). Patients were stratified into three age cohorts: ≤ 59, 60–69 and ≥70 years. The BT prescription dose was prescribed to the prostate gland with generous peri-prostatic margins and the proximal 10mm of the seminal vesicles. 94.6% received supplemental EBRT (45–50.4 Gy) and 63.3% received androgen deprivation therapy (ADT) (median duration 12 months). Post-implant CT-based dosimetry was performed on day 0. BF was defined as a PSA > 0.40 ng/mL after nadir. The cause of death was determined for each patient. Patients with metastatic prostate cancer or non-metastatic castrate resistant prostate cancer who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause. Multiple clinical, pathologic and treatment were evaluated for impact on patient outcomes. Results: Of the patients, 87.5% (median follow-up 8.9 years) presented with a single HR factor. The day 0 D90 was 122.5%. Overall, the 15-year BF, PCSM and OM were 12.4%, 5.6% and 51.7%. When stratified by age, there was no significant difference in BF or PCSM. The median post- treatment PSA in biochemically controlled patients was <0.01 ng/mL. In all three cohorts, OM increased linearly for the first 10 years and then approximately doubled from years 10 to 15. Moreover, 239 patients died: 10.9% due to prostate cancer, 38.1% from cardiovascular (CV) disease and 28.4% from other malignancies (to include one rectal and three bladder cancers). In MVA, BF was most closely related to percent positive biopsies (p < 0.001, SHR 1.018), PCSM to Gleason score (p = 0.004, SHR 2.884) and percent positive biopsies (p = 0.005, SHR 1.021) and OM to age (p < 0.001, HR 1.075) and tobacco (p < 0.001, HR 2.374). Conclusions: Despite high cancer control rates, overall survival was limited by a preponderance of CV and non-prostate cancer deaths, which were 6 times more likely than prostate cancer deaths. The implementation of a comprehensive multidisciplinary survivorship program will be essential to impact longevity in this patient population. Full article

Prostate cancer (PCa) is the most common cancer and the second leading cause of cancer death in American men. Most patients with metastatic disease respond initially to androgen deprivation therapy (ADT) but almost inevitably progress to castration-resistant prostate cancer (CRPC). Identification of markers and drivers of Metastatic CRPC (mCRPC) that (a) represent a progenitor-type cancer cell population, (b) persist in castration-resistant disease, (c) are actionable targets expressed on the cell surface, and (d) are induced by hypoxia is required to facilitate the development of novel targeted therapies. We identified prostatic acid phosphatase (PAP), particularly the transmembrane form (TMPAP), as one such potential target. PAP is both a phosphatase and a 5′ectonucleotidase that generates adenosine. PAP is a human tumor marker first described in 1936 and is still used as an important prognostic marker for advanced metastatic prostate cancer. Our group recently reported that the transmembrane form of the protein (TMPAP) is expressed in CRPC and can serve as a potential therapeutic target. We identified a lead human anti-TMPAP antibody clone 3D8 (3D8-Ab). 3D8-ADCs (Antibody Drug Conjugates) and 3D8-Ab were tested for their ability to reduce tumor size/volume in a xenograft model. The human PAP-expressing PCa cell line VCaP, originally derived from a vertebral metastasis from a patient with CRPC, was inoculated subcutaneously into SCID mice. Treatment with either 3D8-Ab or 3D8-ADC significantly reduced tumor size and increased animal survival. These data indicate that targeting PAP with monoclonal antibodies either alone or conjugated to toxins has the potential to treat CRPC. Full article

Lutetium-177-PSMA-617 (Lu-PSMA) radioligand therapy (RLT) is established in metastatic castration-resistant prostate cancer (mCRPC), with regulatory approvals based on the VISION and TheraP trials. Subsequent trials have extended the evidence to taxane-naive mCRPC (PSMAfore) and demonstrated that combining Lu-PSMA with enzalutamide yields a significant overall survival benefit over enzalutamide alone (ENZA-p). However, higher and more homogeneous PSMA expression in treatment-naive disease, combined with lower tumor burden and preserved bone marrow reserve, provides a biological rationale for deploying RLT earlier in the disease course. In metastatic hormone-sensitive prostate cancer (mHSPC), the Phase III PSMAddition trial reported improved radiographic progression-free survival when Lu-PSMA was added to standard androgen deprivation therapy (ADT) plus androgen receptor pathway inhibitor (ARPI), and the Phase II UpFrontPSMA trial demonstrated enhanced biochemical responses with Lu-PSMA induction before docetaxel. In oligometastatic and oligorecurrent disease, the BULLSEYE and LUNAR trials have shown progression-free survival benefits, raising the possibility of deferring androgen deprivation therapy and its associated morbidity. Meanwhile, next-generation radionuclides, including actinium-225 (WARMTH) and the dual beta-Auger emitter terbium-161 (VIOLET), are entering clinical development to address the radiobiological limitations of Lutetium-177. This review synthesizes the evidence for PSMA-targeted radioligand therapy across the prostate cancer disease continuum and discusses patient selection, treatment sequencing, and the access and cost-effectiveness considerations that will shape adoption in earlier disease settings. Full article

Background/Objectives: Metastatic prostate cancer is increasing in the Gulf Cooperation Council countries. This study presents a multimodal treatment protocol incorporating radiotherapy to primary and metastatic sites, guided by PSMA PET/CT, combined with systemic therapy for non-metastatic pelvic node-positive and de novo low-volume metastatic prostate cancer. Methods: We conducted a retrospective cohort study of patients treated with radical radiotherapy doses (68 Gy/25 Fr or 78 Gy/39 Fr) to the prostate gland and gross pelvic disease, and SBRT (35–40 Gy/5 Fr) to distant bone metastases. All patients received LHRH agonists ± abiraterone/prednisone or enzalutamide. Results: Twenty-four consecutive patients were analyzed. The median age was 70.1 years (IQR, 65.7–77.7), the median baseline PSA was 27.9 ng/mL (IQR = 19.7–53.8), and median follow up was 24 months (IQR = 20.4–31.2). Clinical staging was cT3b in (46%), cT2 in (25%), cT4 in (17%), cT3a in (13%) of patients. Pelvic nodal involvement (cN1) was present in 91.7% of patients, while 54.1% had metastatic disease. Treatment was well tolerated. Acute toxicity was predominantly grade 1 genitourinary (GU) toxicity, occurring in 87.5% of patients, with grade 2 GU toxicity observed in 8.2% and no acute gastrointestinal (GI) toxicity. Late toxicity remained minimal, with grade 1 and grade 2 GU toxicity reported in 45.8% and 4.2% of patients, respectively, and no late GI toxicity. Mild systemic treatment-related toxicities were reported in 25% of patients, including sexual dysfunction, hypokalemia, muscle weakness, osteoporosis and depression/anxiety. At the six-month follow-up PSMA PET/CT assessment, 85.7% achieved a complete metabolic response, and 14.2% achieved a partial response. Biochemically, 75% of patients achieved undetectable PSA levels (<0.01 ng/mL), with all patients achieving a PSA nadir < 0.2 ng/mL. Conclusions: This first, hypothesis-generating real-world experience from the GCC, suggests that an integrated approach combining systemic therapy with metastasis-directed therapy is feasible. Prospective randomized studies are required to validate these results. Full article

Background: Prostate cancer (PCa) is the most commonly diagnosed malignancy in men and a leading cause of cancer-related mortality worldwide. Growing evidence indicates that metabolic syndrome components, including obesity, insulin resistance, and hyperglycemia, contribute to PCa development, and progression to more aggressive form. At the same time, standard treatments such as androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) significantly improve oncologic outcomes but are associated with adverse metabolic effects, including increased fat mass, insulin resistance, and sarcopenia, potentially worsening patients’ overall metabolic profile and quality of life. Tumor progression in PCa is strongly driven by androgen receptor (AR) signaling, which is closely linked to cellular metabolic reprogramming, highlighting metabolism as a potential therapeutic target. Aim: The aim of this study was to evaluate and synthesize current evidence on the role of the ketogenic diet (KD) in PCa, with particular emphasis on its interaction with hormonal therapies, underlying metabolic and endocrine mechanisms, and its potential application as an adjunctive strategy in integrated oncologic care. Results: The KD, characterized by high fat and very low carbohydrate intake, induces a metabolic state of ketosis that reduces circulating glucose, insulin, and insulin-like growth factor 1 (IGF-1), potentially counteracting metabolic alterations associated with PCa and its treatments. Preclinical studies consistently demonstrate that carbohydrate restriction and KD can slow tumor growth, modulate key oncogenic pathways such as PI3K/AKT/mTOR, reduce systemic insulin signaling, and enhance survival in prostate cancer models. Additionally, emerging evidence suggests possible synergistic effects when KD is combined with standard therapies, including ADT and immunotherapy. Clinical data, although limited, indicate that low-carbohydrate dietary interventions may improve metabolic parameters and could delay biochemical progression, as suggested by increased prostate-specific antigen (PSA) doubling time. However, results across studies remain heterogeneous, and robust evidence on long-term oncologic outcomes is lacking. Conclusions: Overall, the KD represents a promising but still experimental strategy in PCa management, requiring careful nutritional supervision to avoid adverse effects such as unintended weight loss or sarcopenia. Further well-designed randomized clinical trials are needed to clarify its safety, efficacy, and role in routine clinical practice. Full article

Treatment intensification with androgen receptor pathway inhibitors (ARPIs) and/or docetaxel in addition to androgen deprivation therapy (ADT) improves survival for men with metastatic hormone-sensitive prostate cancer (mHSPC), yet real-world uptake has historically been low. We conducted a population-based retrospective cohort study of Ontario men aged ≥66 years diagnosed with de novo mHSPC between 2014 and 2022 using linked administrative health data, defining treatment intensification as initiation of an ARPI and/or docetaxel with ADT within six months of diagnosis. Quarterly intensification rates were modeled using autoregressive integrated moving average (ARIMA) time-series methods with nonlinear trend specifications, and competing models were compared using information criteria, out-of-sample hold-out forecast accuracy, and long-horizon extrapolation behaviour to project uptake through 2030. Among 6099 men, 24% received treatment intensification, with quarterly intensification rates increasing from 3% in 2014 to 56% in 2022. A restricted cubic spline ARIMA model (ARIMA(1,0,1) + RCS3) was selected as the primary base-case forecast because it showed superior out-of-sample hold-out accuracy and more tempered long-horizon extrapolation. The cubic specification was retained as an upper-bound scenario, reflecting the possibility of continued aggressive momentum in treatment adoption. Both specifications captured a marked inflection after 2020 that temporally coincided with guideline updates and funding expansions. Near-term base-case projections (through 2026) suggest continued growth in intensification toward 80–85%, with the upper-bound scenario approaching saturation more quickly. Projections beyond 2026 are exploratory and presented for methodological completeness, given the eight-year horizon relative to a nine-year observation window and the widening prediction intervals at extended horizons. Despite substantial growth over time, treatment intensification remains incomplete in routine practice. These findings are temporally consistent with the impact of policy and funding changes on the adoption of evidence-based therapy and underscore the need for ongoing implementation efforts to address persistent clinical and system-level barriers to equitable access. Full article

Background: Androgen deprivation therapy (ADT) is widely used in the management of prostate cancer (PCa) and remains a cornerstone of treatment across multiple disease settings. Although ADT contributes substantially to disease control, it also induces significant adverse metabolic and body composition changes. These alterations include loss of lean mass, increased fat mass, and deterioration in muscle quality, together contributing to a clinical phenotype consistent with sarcopenic obesity (SO). Importantly, ADT-induced SO is characterized not only by reductions in skeletal muscle mass but also by impaired muscle quality, particularly the fatty infiltration of skeletal muscle, or myosteatosis, an underrecognized but defining feature of this syndrome. Methods: This narrative review examines current evidence regarding interventions aimed at mitigating sarcopenic obesity in men treated with ADT for prostate cancer, identifies key gaps in the literature, and proposes a mechanism-driven path forward for intervention development. Results: Several exercise- and nutrition-based interventions have been evaluated in men receiving ADT and demonstrate improvements in selected outcomes such as muscle strength, body composition, and metabolic parameters. However, most studies have been limited by small sample sizes, short intervention durations, and a focus on isolated intervention components. Importantly, muscle quality and intramuscular fat infiltration (myosteatosis), a central component of sarcopenic obesity, have rarely been incorporated as biomarkers or endpoints in intervention trials targeting men receiving ADT. Conclusions: Future interventions designed to mitigate SO and its associated metabolic abnormalities should evaluate comprehensive, bundled strategies initiated early during ADT and sustained long enough to capture clinically meaningful changes. Outcomes should include biomarkers of muscle mass, strength, and quality, including imaging-based measures of myosteatosis, along with metabolic syndrome markers, inflammatory mediators, functional outcomes, adherence, and quality of life. These changes should evaluate the correlation with underlying biological mechanisms such as NF-κB signaling and pro-inflammatory cytokines. Such data may inform future phase III trials and ultimately support clinical strategies to mitigate ADT-related sarcopenic obesity and its downstream cardiometabolic and oncologic consequences. Full article

Poly(ADP-ribose) polymerase inhibitors (PARPi) have reshaped therapy for advanced prostate cancer, yet durable benefit remains concentrated in BRCA1/2-altered tumors, especially BRCA2, and most responders eventually relapse. Here, we frame PARPi response and resistance through a unifying model in which DNA damage response (DDR) rewiring (e.g., homologous recombination repair (HRR) restoration, fork protection, checkpoint tolerance, and altered drug handling) converges with treatment-induced dormancy and quiescent therapy-tolerant residual states that sustain minimal residual disease (MRD) under androgen receptor pathway inhibition (ARPI) and PARP blockade. We synthesize clinical and translational evidence for PARPi monotherapy and PARPi-based combinations across disease states. In first-line metastatic castration-resistant prostate cancer (mCRPC), PARPi plus ARPI consistently prolongs radiographic progression-free survival, with the greatest benefit in HRR-altered tumors, and emerging overall-survival signals in selected subgroups. In later-line settings, monotherapy activity is most robust in BRCA2-mutated disease, whereas non-BRCA HRR alterations show heterogeneous and often modest responses, underscoring the need for biomarkers beyond gene panels. We also discuss combination strategies with DDR-targeting agents, radioligand therapies, and immunotherapy, and summarize ongoing phase III programs in metastatic castration-sensitive prostate cancer (mCSPC). Finally, we outline practical considerations for biomarker-informed patient selection, monitoring, sequencing, and toxicity management, with particular emphasis on intercepting MRD and resistance evolution. Full article