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PurposeTo evaluate fibroblast-activation-protein (FAP) expression in different clinical stages of prostate cancer (PC) with regards to utility of [68 Ga]Ga-FAPI-04 PET/CT imaging in patients with castration-resistant PC (CRPC).MethodsTissue microarrays (TMAs) were constructed from prostatic tissue from 94 patients at different stages of PC (primary PC, patients undergoing neoadjuvant androgen deprivation therapy, CRPC, and neuroendocrine PC (NEPC)) and were stained with anti-FAP monoclonal antibody. A positive pixel count algorithm (H-Index) was used to compare FAP expression between the groups. Additionally, three men with advanced CRPC or NEPC underwent [68 Ga]Ga-FAPI-04 PET/CT, and PET positivity was analyzed.ResultsThe mean H-index for benign tissue, primary PC, neoadjuvant androgen deprivation therapy before radical prostatectomy, CRPC, and NEPC was 0.018, 0.031, 0.042, 0.076, and 0.051, respectively, indicating a significant rise in FAP expression with advancement of disease. Corroborating these findings [68 Ga]Ga-FAPI-04 PET/CT was highly positive in men with advanced CRPC.ConclusionIncreased FAP tissue expression supports the use of FAP inhibitor (FAPI)-molecular theranostics in CRPC.

Background Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced renal cell carcinoma (RCC), but their use is associated with immune-related adverse events, including hepatic adverse events (irHAEs). Methods We retrospectively analysed 105 RCC patients treated with ICIs as first-line therapy between 2018 and 2023 at the University Hospital of Essen. Patients were categorized by the development of irHAE, defined per CTCAE grading v5.0. Multivariable logistic regression was used to identify risk factors, while Kaplan-Meier survival analyses evaluated PFS and OS. Results Among the cohort, 16.19% ( n  = 17) developed irHAE, while 8.57% ( n  = 9) experienced higher-grade events. Combination therapy with tyrosine kinase inhibitors (TKIs) was associated with a higher likelihood of irHAE (OR: 7.69, p  = 0.037) compared to ICI-only regimens, with cabozantinib showing a significantly shorter time to onset (35 vs. 84 days; p  < 0.001). Patients with a BMI ≥ 25 had a significantly increased risk ( p  = 0.011). Differences in PFS (18.63 vs. 19.87 months; p  = 0.099) and OS (27.80 vs. 23.87 months; p  = 0.36) were not statistically significant. Conclusions The combination of ICI with TKI posed higher risks for irHAE in RCC patients. While survival outcomes were unaffected, the results underscore the need for tailored monitoring and management. Prospective studies are warranted to refine therapeutic approaches.

FHIR (Fast Healthcare Interoperability Resources) has been proposed to enable health data interoperability. So far, its applicability has been demonstrated for selected research projects with limited data. This study aimed to design and implement a conceptual medical intelligence framework to leverage real-world care data for clinical decision-making. A Python package for the use of multimodal FHIR data (FHIRPACK [FHIR Python Analysis Conversion Kit]) was developed and pioneered in 5 real-world clinical use cases, that is, myocardial infarction, stroke, diabetes, sepsis, and prostate cancer. Patients were identified based on the ICD-10 (International Classification of Diseases, Tenth Revision) codes, and outcomes were derived from laboratory tests, prescriptions, procedures, and diagnostic reports. Results were provided as browser-based dashboards. For 2022, a total of 1,302,988 patient encounters were analyzed. (1) Myocardial infarction: in 72.7% (261/359) of cases, medication regimens fulfilled guideline recommendations. (2) Stroke: out of 1277 patients, 165 received thrombolysis and 108 thrombectomy. (3) Diabetes: in 443,866 serum glucose and 16,180 glycated hemoglobin A measurements from 35,494 unique patients, the prevalence of dysglycemic findings was 39% (13,887/35,494). Among those with dysglycemia, diagnosis was coded in 44.2% (6138/13,887) of the patients. (4) Sepsis: In 1803 patients, Staphylococcus epidermidis was the primarily isolated pathogen (773/2672, 28.9%) and piperacillin and tazobactam was the primarily prescribed antibiotic (593/1593, 37.2%). (5) PC: out of 54, three patients who received radical prostatectomy were identified as cases with prostate-specific antigen persistence or biochemical recurrence. Leveraging FHIR data through large-scale analytics can enhance health care quality and improve patient outcomes across 5 clinical specialties. We identified (1) patients with sepsis requiring less broad antibiotic therapy, (2) patients with myocardial infarction who could benefit from statin and antiplatelet therapy, (3) patients who had a stroke with longer than recommended times to intervention, (4) patients with hyperglycemia who could benefit from specialist referral, and (5) patients with PC with early increases in cancer markers.

Male germ cell tumors (GCT) have excellent survival. Long-term sequelae in cancer survivors are an evolving field. We evaluated the risk of patients with GCT to develop primary hypogonadism and adherence to guideline-recommended therapy in a real-world cohort. Monocentric study at a tertiary cancer centre to evaluate treated GCT-patients (2001–2019). Post therapeutic male endocrine function, International Index of Erectile Function (IIEF)-5 and The aging males’ symptoms rating scale (AMS) questionnaires were assessed. The overall response rates were low, with 44 of 402 contacted patients participating in the study. From these, 32(73%) underwent blood analysis, 42(95%) answered the IIEF-5 and 43(98%) the AMS. Latent hypogonadism (serum testosterone 8–12 nmol/l) was found in n  = 9 (28%) and manifest hypogonadism (testosterone < 8 nmol/l) in n  = 8 (25%). 50% ( n  = 21) indicated erectile dysfunction on IIEF-5 (cut off ≤ 21 pts.) and 62.8% ( n  = 27) reported symptomatic affection on AMS (cut off ≥ 27 pts.). Majority of tested patients revealed different degrees of hypogonadism. Standard instruments were able to detect gonadal damage in > 50%, which underscored the clinical need to evaluate endocrine function in cancer survivors. We further indicated the difficulties of today’s research and provided starting points to assess barriers for study participations.

Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool. Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80-20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models. For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/. The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients.

Students experience challenges with persistence, retention, graduation, and overall academic success in colleges and universities, particularly when courses are taught by adjunct instructors. Using a sample of 21,274 student results in three different general education disciplines from 2010 to 2019, the authors found that there was a disparity between adjunct and full-time faculty members in those key outcomes. The purpose of this study is to analyze data about student persistence, retention, and academic skills and its relationships with type of instructor (adjunct or non-adjunct) to consider the means by which the results may help to respond effectively to negative indicators in those areas. In addition to including adjunct instructors in professional development and student engagement activities on campuses, strategically hiring full-time faculty may result in gains that offset the higher financial outlay for those instructors.

Background Despite constant improvements, incontinence is one of the most relevant and quality‐of‐life‐reducing side effects of radical prostatectomy (RP) and, in addition to patient‐specific factors such as age, the experience of the surgeon/center and the surgical technique used play an important role. Aims To present current real‐world data on short‐term incontinence after RP from one of the largest German rehabilitation centers in 2022 and to compare it to the results from the same institution in 2016. Methods and Results Retrospective, unicentric, univariate analysis of data from 1394 men after RP in 2022 on admission and discharge from the rehabilitation clinic. Incontinence defined as ≥ 1 pad/day was evaluated by quantitative measuring all day incontinence under a defined graduation and compared to the results of 2016. Totally, 1393 men were available for analysis in 2022 compared to 1390 in 2016. Median age for both cohorts was 66 years with minor differences in preoperative PSA levels. Despite different surgical approaches, no significant change in short‐term incontinence rates in 2016 and 2022 were noted at discharge (76.9% vs. 77.9%, p = 0.56). A notable increase in patients with ISUP grade Group 2 and a shift towards robotic surgery were observed in 2022 (45.5%–71%). While nerve sparing led to a significant improvement in continence (p < 0.01), lymphadenectomy and T‐stage were not related to any significant increase in short‐term incontinence rates. Comparing age groups within the cohort, patients > 69 years exhibited the highest risk of short‐term incontinence and least likelihood of regaining continence during rehabilitation (p < 0.01). Men treated at a certified prostate cancer center had significantly (p < 0.01) lower short‐term incontinence rates. Conclusion Our study shows little improvement in short‐term postoperative incontinence rates after RP in Germany in the last 6 years and known risk factors for postoperative incontinence like age, nerve‐sparing surgery, and level of experience were reproduced in our analyses. We conclude not only to carefully select but also to counsel patients before being treated for prostate cancer and to strongly advice treatment at certified centers.

Androgen deprivation therapy (ADT) alone has been the standard of care for many years in men with metastatic prostate cancer. Due to the limited survival under this monotherapy, many new treatment options have been developed in the last few years. Regarding hormone-sensitive prostate cancer, combination therapies of two or three agents of ADT, androgen receptor signaling inhibitors (ARSI) and chemotherapy have been established and led to a significant benefit in overall survival. Additionally, in patients with metastatic castration-resistant prostate cancer, there are many new therapeutic approaches. Chemotherapy alone has been the standard of care in this situation. In the last years, some new therapeutic options have been developed, which led to an improved survival after progression under chemotherapy. These therapies include ARSI, PARP inhibitors and Lu-PSMA radioligand therapy. The use of a bispecific T-cell engager (BiTE) in this setting is a new promising therapeutic approach, which has not been established as standard of care yet. The role of immunotherapy in prostate cancer is still under investigation. Overall, many new treatment options make prostate cancer therapy a challenging and promising field.

Purpose To give an overview of the multicenter Prostate Cancer Outcomes (PCO) study, involving paper-based and web-based collection of patient-reported outcome measures (PROM) in patients undergoing local treatment for prostate cancer in certified centers in Germany. The PCO study is part of the larger Movember-funded TrueNTH Global Registry. The article reports on the study’s design and provides a brief progress report after the first 2 years of data collection. Methods Prostate cancer centers (PCCs) certified according to German Cancer Society requirements were invited to participate in collecting patient-reported information on symptoms and function before and at least once (at 12 months) after treatment. The data were matched with disease and treatment information. This report describes progress in patient inclusion, response rate, and variations between centers relative to online/paper use, and also data quality, including recruitment variations relative to treatment in the first participating PCCs. Results PCC participation increased over time; 44 centers had transferred data for 3094 patients at the time of this report. Patient recruitment varied widely across centers. Recruitment was highest among patients undergoing radical prostatectomy. The completeness of the data was good, except for comorbidity information. Conclusions The PCO study benefits from a quality improvement system first established over 10 years ago, requiring collection and harmonization of a predefined clinical dataset across centers. Nevertheless, establishing a PROM routine requires substantial effort on the part of providers and constant monitoring in order to achieve high-quality data. The findings reported here may be useful for guiding implementation in similar initiatives.

Programmed death ligand-1 (PD-L1) is an immune checkpoint molecule and a widely used therapeutic target in urothelial cancer. Its circulating, soluble levels (sPD-L1) were recently suggested to be associated with the presence and prognosis of various malignancies but have not yet been investigated in upper tract urothelial carcinoma (UTUC). In this study, we assessed sPD-L1 levels in 97 prospectively collected serum samples from 61 UTUC patients who underwent radical nephroureterectomy (RNU), chemotherapy (CTX), or immune checkpoint inhibitor (ICI) therapy. In addition to pretreatment samples, postoperative and on-treatment sPD-L1 levels were determined in some patients by using ELISA. In the RNU group, elevated preoperative sPD-L1 was associated with a higher tumor grade (p = 0.019), stage (p < 0.001) and the presence of metastasis (p = 0.002). High sPD-L1 levels were significantly associated with worse survival in both the RNU and CTX cohorts. sPD-L1 levels were significantly elevated in postoperative samples (p = 0.011), while they remained unchanged during CTX. Interestingly, ICI treatment caused a strong, 25-fold increase in sPD-L1 (p < 0.001). Our results suggest that elevated preoperative sPD-L1 level is a predictor of higher pathological tumor stage and worse survival in UTUC, which therefore may help to optimize therapeutic decision-making. The observed characteristic sPD-L1 flare during immune checkpoint inhibitor therapy may have clinical significance.