Prostate Cancer: Symptoms, Diagnosis & Treatment—3rd Edition

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Dear Colleagues,

This Topic is a continuation of the previous successful Topics "Prostate Cancer: Symptoms, Diagnosis & Treatment" (https://www.mdpi.com/topics/prostate_Cancer; https://www.mdpi.com/topics/prostate_Cancer2). The prostate is the largest accessory gland of the male reproductive tract. Together with seminal vesicles and bulbourethral glands, the prostate is responsible for producing an alkaline fluid that forms part of the seminal fluid. The prostates of men over 40 years of age are commonly affected by several pathologies, such as benign prostate hyperplasia and cancer. Prostate cancer is one of the most common cancers among the male population worldwide. According to the World Health Organization (WHO), in 2020, prostate cancer affected approximately 1.41 million men worldwide. Despite significant treatment improvements having been achieved with the advent of targeted and immune-checkpoint-inhibitor-based therapies, cancer remains a primary causes of death worldwide. Therefore, this Topic will consider articles on all types of research on prostate cancer, including in vitro and in vivo approaches. Research on the impacts of the tumor macroenvironment (microbiota, diet, physical exercise) on tumor biology, as well as review studies, is also welcome. We invite scientists to publish their excellent work in one of the following journals: Cancers, Diagnostics or Medicina.

Dr. Ana Faustino
Prof. Dr. Lúcio Lara Santos
Prof. Dr. Paula Oliveira
Topic Editors

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Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Cancers cancers	4.8	9.0	2009	17.5 Days	CHF 2900	Submit
Current Oncology curroncol	3.6	6.1	1994	22.6 Days	CHF 2200	Submit
Diagnostics diagnostics	3.8	6.9	2011	20.4 Days	CHF 2600	Submit
Medicina medicina	2.9	4.6	1920	17.4 Days	CHF 2200	Submit

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Published Papers (6 papers)

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All Cancers Diagnostics Medicina Current Oncology

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11 pages, 711 KB  

Open AccessArticle

Quality of Life and Psychological Factors in Patients with Metastatic Prostate Cancer Receiving Androgen Receptor–Targeted Therapies: A Prospective Cross-Sectional Real-World Study

by Selahattin Çelik, Salih Karatlı, Mehmetcan Atak, Hatice Ayyıldız Sevim, Gökşen İnanç İmamoğlu and Samed Rahatlı

Medicina 2026, 62(6), 1175; https://doi.org/10.3390/medicina62061175 - 17 Jun 2026

Viewed by 375

Abstract

Background and Objectives: Quality of life (QoL) has become an essential outcome in patients with metastatic prostate cancer, particularly in the era of androgen receptor (AR)-targeted therapies. Although these agents improve survival, their differential impact on QoL and the role of psychological [...] Read more.

Background and Objectives: Quality of life (QoL) has become an essential outcome in patients with metastatic prostate cancer, particularly in the era of androgen receptor (AR)-targeted therapies. Although these agents improve survival, their differential impact on QoL and the role of psychological factors remain incompletely understood. This study aimed to evaluate QoL, functional outcomes, and psychological status, and to identify factors associated with poor QoL in a real-world cohort. Materials and Methods: This prospective cross-sectional, single-center observational study included 130 patients with metastatic prostate cancer receiving AR-targeted therapies (abiraterone, enzalutamide, or apalutamide/darolutamide). QoL was assessed using the EORTC QLQ-C30 questionnaire, and psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS). Patients were stratified according to treatment groups, and comparisons were performed using appropriate statistical tests. Logistic regression analyses were conducted to determine factors independently associated with poor QoL. Results: Exploratory differences in global QoL were observed among treatment groups (p = 0.007), with lower global QoL scores in the abiraterone group and numerically higher emotional and cognitive functioning scores in the enzalutamide group. Symptom analysis demonstrated higher nausea/vomiting scores in the abiraterone group (p = 0.022), whereas other symptom domains were comparable across treatment groups. In multivariable analysis, anxiety (odds ratio [OR]: 6.62) and depression (OR: 3.40) were independently associated with poor QoL, while treatment type was not independently associated with poor QoL after multivariable adjustment. Conclusions: Although unadjusted QoL scores differed across AR-targeted therapy groups, psychological factors—particularly anxiety and depression—were significantly associated with poorer QoL in patients with metastatic prostate cancer. These findings highlight the importance of integrating routine psychosocial assessment and supportive care strategies into clinical practice to optimize patient-centered outcomes. However, given the cross-sectional and exploratory nature of the study, the findings should be interpreted cautiously. Full article

(This article belongs to the Topic Prostate Cancer: Symptoms, Diagnosis & Treatment—3rd Edition)

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14 pages, 710 KB  

Open AccessArticle

Development and Internal Validation of a Side-Specific Nomogram Integrating mpMRI and Biopsy Features to Guide Nerve-Sparing Decision Making in Prostate Cancer with Capsular Contact

by Yusuf Ahmed, Kateryna Diahovets, Tician Schnitzler, Lea Seiler, Alexander Cornelius, Fiona Burkhard, Georg Müller, Rainer Grobholz, Marco Cattaneo, Manuel Walter, Livio Nowak, Pirmin Wolfsgruber, Stephen Wyler, Lukas Prause, Maciej Kwiatkowski and Luca Afferi

Cancers 2026, 18(11), 1788; https://doi.org/10.3390/cancers18111788 - 29 May 2026

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Abstract

Background: Preoperative side-specific identification of extracapsular extension (ECE) is important for selecting an appropriate nerve-sparing strategy at radical prostatectomy. Patients with multiparametric magnetic resonance imaging (mpMRI)-defined capsular contact represent a clinically challenging subgroup because contact raises concern for ECE but does not [...] Read more.

Background: Preoperative side-specific identification of extracapsular extension (ECE) is important for selecting an appropriate nerve-sparing strategy at radical prostatectomy. Patients with multiparametric magnetic resonance imaging (mpMRI)-defined capsular contact represent a clinically challenging subgroup because contact raises concern for ECE but does not uniformly indicate extraprostatic disease. We aimed to develop a side-specific nomogram for individualized ECE prediction and perform preliminary internal validation in this selected population. Materials and Methods: We retrospectively analyzed 323 prostate lobes from 286 patients with biopsy-proven, non-metastatic prostate cancer and mpMRI-defined capsular contact who underwent robot-assisted radical prostatectomy between 2015 and 2021 at a single institution. The dataset was randomly split into training (70%) and testing (30%) cohorts. Three multivariable logistic-regression models were developed and compared. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC-ROC), calibration by intercept and slope, and clinical utility by decision curve analysis. A nomogram was derived from the best-performing model in the internal split-sample comparison. Results: Side-specific ECE was present in 110/323 lobes (34.1%). Among the candidate models, the forward-selection model showed the most favorable apparent performance, with an AUC-ROC of 0.85 in training and 0.83 in testing, together with good test-set calibration (intercept 0.24; slope 0.97). The final model included a capsular contact length ≥10 mm, percentage tumor involvement in positive biopsy cores, number of positive biopsy cores, and index lesion size. At a 10% predicted risk threshold, 32% of lobes were classified as low risk, with an observed ECE rate of about 5%. Conclusions: We developed a side-specific nomogram tailored to patients with mpMRI-defined capsular contact and performed preliminary internal validation. The model may aid preoperative side-specific risk assessment relevant to nerve-sparing planning, but external validation and assessment of clinical impact are required before clinical adoption. Full article

(This article belongs to the Topic Prostate Cancer: Symptoms, Diagnosis & Treatment—3rd Edition)

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20 pages, 342 KB  

Open AccessReview

Prostate Cancer Screening in Contemporary Era: PSA-Based Testing and Risk-Adapted Approaches

by Michele Brancaccio, Armando Galdieri, Andrea Cosenza, Francesco Barletta, Pietro Scilipoti, Leonardo Quarta, Paolo Zaurito, Alfonso Santangelo, Alessandro Viti, Angelo Occhi, Maria Elena Porzi, Alessia Colistro, Giulia Roca, Simone Scuderi, Vito Cucchiara, Armando Stabile, Francesco Montorsi, Alberto Briganti and Giorgio Gandaglia

Cancers 2026, 18(10), 1547; https://doi.org/10.3390/cancers18101547 - 10 May 2026

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Abstract

Prostate cancer (PCa) screening has long relied on PSA testing, a strategy that has shaped diagnostic pathways for decades but remains limited by substantial overdiagnosis and downstream overtreatment. As screening practices evolve, the relevance of historical evidence must be reconsidered in the context [...] Read more.

Prostate cancer (PCa) screening has long relied on PSA testing, a strategy that has shaped diagnostic pathways for decades but remains limited by substantial overdiagnosis and downstream overtreatment. As screening practices evolve, the relevance of historical evidence must be reconsidered in the context of contemporary diagnostic workflows that now incorporate imaging, refined biopsy techniques, and risk-adapted management. This narrative review examines the transition from PSA-only screening toward modern, risk-adapted early detection strategies. We synthesize evidence supporting the integration of mpMRI, refined biopsy techniques, and active surveillance (AS) as key components of contemporary screening pathways aimed at improving the detection of clinically significant disease while minimizing unnecessary interventions. Particular emphasis is placed on second-line MRI-based approaches, which consistently reduce the number of avoidable biopsies and enhance the diagnostic precision. In addition, we review the role of blood-based and genomic biomarkers in pre-biopsy risk stratification, discussing established tools within a unified framework of individualized screening. The review also contextualizes very recent regulatory developments, including the FDA approval of a novel structure-based PSA assay, as part of the ongoing evolution of biomarker-supported screening rather than a paradigm shift. Overall, this article provides a timely synthesis of mature randomized evidence and emerging diagnostic innovations, offering a clinically grounded perspective on how PCa screening is being reshaped toward more personalized and harm-aware strategies. Full article

(This article belongs to the Topic Prostate Cancer: Symptoms, Diagnosis & Treatment—3rd Edition)

3 pages, 778 KB  

Open AccessInteresting Images

Pretherapeutic ¹⁸F-PSMA PET/CT Reveals Incidental Tracheal Epithelial–Myoepithelial Carcinoma

by Farid Gossili, Nelson Fuentes-Martinez and Christian Høyer

Diagnostics 2026, 16(6), 883; https://doi.org/10.3390/diagnostics16060883 - 16 Mar 2026

Viewed by 509

Abstract

A 75-year-old man with newly diagnosed high-risk prostate cancer (cT3bN0M0) underwent ¹⁸F-PSMA PET/CT, which demonstrated intense tracer uptake in a left tracheal mass causing near-complete luminal obstruction, raising suspicion of a primary lung malignancy or metastatic disease. Endoscopic debulking was performed due [...] Read more.

A 75-year-old man with newly diagnosed high-risk prostate cancer (cT3bN0M0) underwent ¹⁸F-PSMA PET/CT, which demonstrated intense tracer uptake in a left tracheal mass causing near-complete luminal obstruction, raising suspicion of a primary lung malignancy or metastatic disease. Endoscopic debulking was performed due to progressive respiratory symptoms with dyspnea. Histopathology and immunohistochemistry (p63, SMA, CK5/6 positive; PSA, NKX3.1, and AR negative, with downregulated PSMA-expression) established the diagnosis of low-grade epithelial–myoepithelial carcinoma of the trachea. Following debulking, the patient’s symptoms resolved, and a watchful-waiting strategy was adopted for the tracheal tumor, while curative-intent therapy for prostate cancer continued. This case highlights that ¹⁸F-PSMA PET/CT may reveal rare, intensely PSMA-avid non-prostatic neoplasms and underscores the importance of recognizing atypical uptake patterns to avoid misinterpretation during prostate cancer staging. Full article

(This article belongs to the Topic Prostate Cancer: Symptoms, Diagnosis & Treatment—3rd Edition)

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12 pages, 671 KB  

Open AccessArticle

PSA Zero Radiographic Disease Progression on PSMA PET/CT

by Ahmed M. Mahmoud, Carter Day, Eman E. Ahmed, Mohamed E. Ahmed, Rimki Haloi, Mindie Mahon, Yalda Nikanpour, Daniel S. Childs, Jacob J. Orme, Ayse Tuba Kendi, Geoffrey B. Johnson, Eugene D. Kwon and Jack R. Andrews

Cancers 2026, 18(5), 831; https://doi.org/10.3390/cancers18050831 - 4 Mar 2026

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Abstract

Background and Objective: Radiographic progression in prostate cancer (PCa) can occur even when prostate-specific antigen (PSA) levels are undetectable. We aimed to determine the frequency and characteristics of radiographic disease progression (rDP) on PSMA PET/CT in patients with undetectable PSA, referred to as [...] Read more.

Background and Objective: Radiographic progression in prostate cancer (PCa) can occur even when prostate-specific antigen (PSA) levels are undetectable. We aimed to determine the frequency and characteristics of radiographic disease progression (rDP) on PSMA PET/CT in patients with undetectable PSA, referred to as PSA zero rDP. Methods: We analyzed the Mayo Clinic PSMA PET Prostate Cancer Registry to identify patients with rDP on PSMA PET/CT despite undetectable PSA levels. Disease progression was confirmed via biopsy or treatment response. The cohort included patients with non-metastatic and metastatic hormone-sensitive disease, as well as those with castration-resistant prostate cancer at the time of imaging. Overall survival (OS) was estimated using the Kaplan–Meier method. Group comparisons were performed with the log-rank test. Univariate Cox regression was used to identify factors associated with poor OS. Key findings and Limitations: Among 2141 patients imaged between 2021 and 2023, 257 (12%) had PSA zero rDP. Sixty-one percent had initially localized disease; 39% had de novo metastatic disease. Median (IQR) time from diagnosis to PSA zero rDP was 51.9 (18.4–115.5) months. A total of 184 patients (72%) progressed to castration-resistant PCa. Sites of rDP included bone (57%), visceral (15%), lymph node (18%), and local recurrence (10%). During median follow-up of 8.1 (3.5–11.9) months, 5% of patients died. Only visceral metastases were significantly associated with poorer OS (p < 0.0001). Conclusions and Clinical Implications: Prostate cancer patients frequently develop metastatic disease with undetectable PSA values. Our findings suggest the use of periodic advanced imaging techniques, irrespective of PSA value, for more prompt detection and early management of disease progress. Full article

(This article belongs to the Topic Prostate Cancer: Symptoms, Diagnosis & Treatment—3rd Edition)

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11 pages, 382 KB  

Open AccessArticle

Prostate Cancer Diagnosis by Transurethral Resection of the Prostate Is Associated with Compromised Oncologic Outcomes Post-Prostatectomy

by Abdullah Al-Khanaty, Marlon Perera, Brendan Yanada, Melanie Evans, Declan G. Murphy, Damien Bolton and Nathan Papa

Cancers 2026, 18(4), 569; https://doi.org/10.3390/cancers18040569 - 9 Feb 2026

Viewed by 1254

Abstract

Background: Following transurethral resection of the prostate (TURP) for lower urinary tract symptoms, incidental diagnosis of prostate cancer occurs in 2–10%. The significance of incidental prostate cancer on TURP compared to diagnosis via traditional diagnostic pathways is unclear. We aimed to compare post-prostatectomy [...] Read more.

Background: Following transurethral resection of the prostate (TURP) for lower urinary tract symptoms, incidental diagnosis of prostate cancer occurs in 2–10%. The significance of incidental prostate cancer on TURP compared to diagnosis via traditional diagnostic pathways is unclear. We aimed to compare post-prostatectomy outcomes in patients diagnosed with prostate cancer on TURP and prostate biopsy, using a population-based clinical quality registry. Methods: Data were extracted from the Victorian Prostate Cancer Outcomes Registry (PCOR-Vic). Patients who underwent prostatectomy between September 2008 and September 2020 and who were diagnosed by needle biopsy or TURP were included. The association between diagnosis method and overall survival was examined with Kaplan–Meier plots and the log-rank test. Multivariable Cox proportional hazards regression adjusting for PSA, age, year of surgery, diagnostic Gleason grade group and margin status was also used. Association with prostate cancer-specific mortality was examined with Fine and Gray competing hazards regression including the same covariates as above. Results: In total, 12022 patients met the inclusion criteria, of which 159 (1.3%) were diagnosed on TURP. After a median 58 months follow-up, diagnosis on TURP was associated with poorer 5-year overall survival at 91.2% (84.2–95.0%) compared to diagnosis on needle biopsy at 96.7% (96.2–97.0%), log-rank p = 0.001. Following multivariable adjustment, the hazard ratio of TURP vs. biopsy patients was 2.33 (95%CI: 1.35–4.01). For prostate cancer-specific mortality, there was a similar estimate; however, the 95% confidence interval crossed one, subHR = 2.24 (95% CI: 0.77–6.57). Conclusions: Diagnosis of prostate cancer on TURP was associated with poorer overall survival when compared to men diagnosed on prostate biopsy. These findings have clinical implications given the increased use of photoselective vaporisation of the prostate, which is characterised by the lack of pathologic tissue for assessment. Full article

(This article belongs to the Topic Prostate Cancer: Symptoms, Diagnosis & Treatment—3rd Edition)

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