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The increasing volume and complexity of biomedical literature pose challenges for making scientific knowledge accessible to lay audiences. Lay summaries, now widely encouraged or required by journals, aim to bridge this gap by promoting health literacy, patient engagement, and public trust. However, many are written by scientists without formal training in plain-language communication, often resulting in limited clarity, readability, and consistency. Generative large language models such as ChatGPT-4 offer a scalable opportunity to support lay summary creation, though their effectiveness within specific clinical domains has not been systematically evaluated at scale. This study aimed to assess ChatGPT-4's performance in generating lay summaries for prostate cancer studies. A secondary objective was to evaluate how prompt design influences summary quality, aiming to provide practical guidance for the use of generative artificial intelligence (AI) in scientific publishing. A total of 204 consecutive articles on prostate cancer were extracted from a high-ranking oncology journal mandating lay summaries. Each abstract was processed with ChatGPT-4 using 2 prompts: a simple prompt based on the journal's guidelines and an extended prompt refined to improve readability. AI-generated and original summaries were evaluated using 3 criteria: readability (Flesch-Kincaid Reading Ease [FKRE]), factual accuracy (5-point Likert scale, blinded rating by 2 clinical experts), and compliance with word count instructions (120-150 words). Summaries were classified as high-quality as a composite outcome if they met all 3 benchmarks: FKRE >30, accuracy ≥4 from both raters, and word count within range. Statistical comparisons used Wilcoxon signed-rank and paired 2-tailed t tests (P<.05). ChatGPT-4-generated lay summaries showed an improvement in readability compared to human-written versions, with the extended prompt achieving higher scores than the simple prompt (median FKRE: extended prompt 47, IQR 42-56; simple prompt 36, IQR 29-43; original 20, IQR 9.5-29; P<.001). Factual accuracy was higher for the AI-generated lay summaries compared to originals (median factual accuracy score: extended prompt 5, IQR 5-5; simple prompt 5, IQR 5-5; original 5, IQR 4-5; P<.001) in this dataset. Compliance with word count instructions was greater for both AI-generated summaries in comparison to originals (wrong number of words; extended prompt 39 (19%), simple prompt 40 (20%), original 140 (69%); P<.001). Between simple and extended prompts, there were no significant differences in accuracy (P=.53) and word count compliance (P=.87). The proportion rated as high-quality was 79.4% for the extended prompt, 54.9% for the simple prompt, and 5.4% for original summaries (P<.001). With optimized prompting, ChatGPT-4 produced lay summaries that, on average, scored higher than author-written versions in readability, factual accuracy, and structural compliance within our dataset. These results support integrating generative AI into editorial workflows to improve science communication for nonexpert audiences. Limitations include focus on a single clinical domain and journal, and absence of layperson evaluation.

Objective To assess the impact of detailed clinical and histopathological criteria on gender-dependent cancer-specific survival (CSS) in a large consecutive series of patients following radical cystectomy (RCE) for muscle-invasive bladder cancer (MIBC). Patients and methods Between 1992 and 2007, 388 men and 133 women (25.5%) underwent RCE for MIBC. A prospectively maintained database was analysed retrospectively. Uni- and multivariable Cox-regression analyses calculated the impact of detailed clinical and histopathological criteria on CSS. Median follow-up was 59 months (2–162). Results Among clinical and histopathological parameters, only type of urinary diversion differed between men and women. In univariable analysis, CSS did not differ between genders. In multivariable Cox-regression analysis, advanced pT-stage (HR = 2.12; P  < 0.001), lymphovascular invasion (LVI) (HR = 3.47; P  < 0.001), time interval between diagnosis of MIBC and RCE exceeding 90 days (HR = 2.07; P  < 0.001) and female gender (HR = 1.35; P  = 0.048) were related to reduced CSS. In separate multivariable Cox-models for time period of surgery between 1992 an 1999 (HR = 1.52; P  = 0.050), age ≤55 years (HR = 3.00; P  = 0.022), presence of LVI (HR = 1.45; P  = 0.031) and female gender were associated with independent reduced CSS. Conclusion Established clinical and histopathological parameters do not differ significantly between both genders in the present series. Reduced CSS in women is present in historic cohorts possibly suggesting improvement in management over the last years. In particular, female gender has a significant negative impact on CSS in patients younger of age and with positive LVI status possibly suggesting different clinical phenotypes.

Purpose To evaluate the still controversially discussed prognostic role of preoperative platelet level (PPL) and thrombocytosis (TC) in patients who undergo surgery for renal cell carcinoma (RCC) based on the largest patient series reported to date. Methods A total of 3,139 patients, who underwent radical or nephron-sparing nephrectomy at four centres, were subdivided based on a threshold for preoperative platelets of 400 × 10 9 cells/L. Univariate and multivariable Cox regression analyses were applied to determine the prognostic influence of PPL and TC on cancer-specific survival (CSS) for patients with localized and metastatic disease at presentation. Results Group 1 (PPL ≤ 400/nl) and Group 2 (PPL > 400/nl) included 2,862 (91 %) and 277 patients (9 %), respectively. With a median follow-up (FU) of 69.5 months (IQR: 35–105), CSS of all patients after 5 years was 84.6 % in Group 1 versus 53.4 % in Group 2 ( p  < 0.001). At multivariable analysis, TC (HR:1.337; p  = 0.007) and continuous PPL (HR:1.001; p  = 0.002) independently predicted a decreased survival. However, integration of these parameters into multivariable models for the entire study group and for patients with localized tumours did only result in marginal improvement of the model quality (0.66 and 1.04 %, respectively). Interestingly, neither TC ( p  = 0.257) nor PPL ( p  = 0.132) significantly influenced survival in M1 patients. Conclusions Preoperative TC turned out an independent predictor for decreased CSS in patients undergoing surgery for localized RCC. However, significant improvement of multivariable models comprising standard clinical and pathological parameters by the inclusion of TC is not achieved. In metastatic disease, TC did not reveal an independent influence on CSS.

Abstract Background The incidence of RCC is increasing worldwide. For most patients with localized RCC, surgery remains the preferred treatment option. We aimed to investigate whether international trends towards minimally invasive procedures and nephron-sparing surgery are reflected in Germany. Methods Pseudonymized inpatient billing data from the AOK (Allgemeine Ortskrankenkassen), a non-profit oriented health insurance organization in Germany, was used for the conduct of the study. A total of 43,936 RCC cases were identified in which either a partial nephrectomy (PN, n = 20,030) or radical nephrectomy (RN, n = 21,906) was performed between 2012 and 2021. The proportions of different surgical procedures over time, as well as mortality (90 days), transfusion rate, reinterventions, and general postsurgical complications (30 days), were evaluated. Due to the use of pseudonymized data, no ethics vote was required. Results During the period of observation, there was a significant shift from RN to PN, with an increase in the proportion of PN among all procedures from 41.0% (1,918/4,684) in 2012 to 57.4% (2,274/3,960) in 2021 (p <0.001). Open surgery decreased for PN and RN but still accounted for the majority of all procedures (2021: 53.2% of PN and 65% of RN). Mortality was higher among patients with RN compared to PN (in hospital: 1.9% vs. 0.6%, 90 days: 4.7% vs. 1.2%). While general complication rates were similar (19.4% after PN versus 20.4% after RN), the reintervention rate was slightly higher after PN at 10.7% than after RN at 7.9%. Transfusion rates decreased significantly in several subgroups, favoring PN and minimally invasive approaches. Open surgical procedures were associated with higher unadjusted complication rates. Conclusions Despite shifts in favor of nephron-sparing surgery and minimally invasive surgery during the study period, open surgery remained the dominant surgical option for the treatment of renal cell carcinoma in Germany as of 2021. The adoption of laparoscopic and robotic-assisted techniques appears to reduce overall perioperative morbidity and consequently improve the quality of care in Germany. Further studies are required to examine patient level trends between type of surgical procedure, complication rates, and oncologic outcomes. Optimizing the assessment of the quality of care would enable further improvement of the quality itself.

Despite the relatively low infection rate following transperineal prostate biopsy (TPB), it remains unresolved whether periprocedural antibiotic prophylaxis (PAP) can be omitted. Our aim was to compare infectious complications (genitourinary infections/GUI, fever, sepsis, readmission rate, 30-day-mortality) following TPB, considering all studies of varying levels of evidence that enable a direct comparison between patients with and without PAP. We performed a comprehensive search in PubMed/Medline, Embase, Web of Science, and Cochrane databases, as well as grey literature sources, to identify reports published until January 2024. All studies comparing the incidence of infectious endpoints following TPB with vs. without PAP were included in the analyses. The GRADE approach was employed to assess the certainty of evidence for each comparison. Twenty-three studies met the inclusion criteria involving 6520 and 5804 patients who underwent TPB with vs. without PAP, respectively. Two of the 23 studies were randomized-controlled trials, not all studies investigated all endpoints. Pooled incidences between patients with vs. without PAP for the endpoints GUI (0.50% vs. 0.37%), fever (0.44% vs. 0.26%), sepsis (0.16% vs. 0.13%), and readmission rate (0.35% vs. 0.29%) showed no significant differences (all p > 0.250). The corresponding odds ratios (including 95% confidence interval) also revealed no statistically significant differences: 1.37 (0.74-2.54) [GUI], 0.87 (0.28-2.66) [fever], 1.30 (0.46-3.67) [sepsis], and 1.45 (0.70-3.03) [readmission rate]. No study reported events regarding 30-day-mortality. In subgroup analyses and sensitivity analyses, TPB without PAP showed no significantly higher complication rates regarding all analyzed endpoints. Infectious complications after TPB occur very rarely and cannot be further reduced by PAP. Considering the results of this systematic review and adhering to the principles of effective antibiotic stewardship, omitting PAP in the context of TPB is advisable.

Background Research on penile cancer (PeCa) is predominantly conducted in countries with centralized treatment of PeCa-patients. In Germany and Austria (G + A), no state-regulated centralization is established, and no information is available on how PeCa-research is organized. Methods Current research competence in PeCa was assessed by a 36-item questionnaire sent to all chairholders of urological academic centers in G + A. Based on PubMed records, all scientific PeCa-articles of 2012–2022 from G + A were identified. Current research trends were assessed by dividing the literature search into two periods (P1: 2012–2017, P2: 2018–2022). A bibliometric analysis was supplemented. Results Response rate of the questionnaire was 75%, a median of 13 (IQR: 9–26) PeCa-patients/center was observed in 2021. Retrospective case series were conducted by 38.9% of participating clinics, while involvement in randomized-controlled trials was stated in 8.3% and in basic/fundamental research in 19.4%. 77.8% declared an interest in future multicenter projects. 205 PeCa-articles were identified [median impact factor: 2.77 (IQR: 0.90–4.37)]. Compared to P1, P2 showed a significant increase in the median annual publication count (29 (IQR: 13–17) vs. 15 (IQR: 19–29), p  < 0.001), in multicenter studies (79.1% vs. 63.6%, p  = 0.018), and in multinational studies (53% vs. 28.9%, p  < 0.001); the proportion of basic/fundamental research articles significantly declined (16.5% vs. 28.9%, p  = 0.041). Four of the top-5 institutions publishing PeCa-articles are academic centers. Bibliometric analyses revealed author networks, primary research areas in PeCa, and dominant journals for publications. Conclusions Given the lack of centralization in G + A, this analysis highlights the need for research coordination within multicenter PeCa-projects. The decline in basic/fundamental research should be effectively addressed by the allocation of funded research projects.

The available randomised controlled trials (RCTs) assessing the influence of peritoneal interposition flaps (PIF) on the reduction of symptomatic lymphoceles (sLCs) post robot-assisted radical prostatectomy (RARP) do not constitute a sufficient follow-up (FU) to assess the long-term effects. The PIANOFORTE trial was the first of these RCTs, showing no sLC reduction at the 3-month FU. Therefore, all 232 patients from the PIANOFORTE trial were invited for long-term FU. One hundred seventy-six patients (76%) presented themselves for FU and constituted the study group (SG). The median FU duration was 43 months. No significant differences in group allocation or LC endpoints at 90 days were observed between SG patients and patients not presenting themselves for the FU. During the FU period, four patients (2.3%) in the SG developed sLCs, and six patients (3.4%) developed asymptomatic lymphoceles (aLCs), which persisted in five patients (2.9%). There were no significant differences between PIF and non-PIF regarding sLC/aLC formation or persistence, newly developed complications, stress urinary incontinence or biochemical/clinical tumour recurrence. Therefore, this long-term FU confirms the primary outcomes of the PIANOFORTE trial that, while PIF does not impact complications or functionality, it does not reduce sLC/aLC rates. Furthermore, it shows the potential occurrence of LC after the third postoperative month.

Background: The relationship between case volume and clinical outcomes is well established for most urological procedures but remains underexplored in prostate ultrasound/MRI fusion biopsy (UMFB). UMFB aims to detect clinically significant prostate cancer (csPCa) by adhering to cancer detection benchmarks for PI-RADS lesions identified via multiparametric MRI (mpMRI). These benchmarks, defined by Ahmed et al., include cumulative cancer detection rate (C-CDR) targets of >80% for PI-RADS 5, >50% for PI-RADS 4, and <20% for PI-RADS 1–3. Methods: This retrospective, single-center study analyzed the case volumes required for two experienced urologists (U1 and U2, each with >15 years of practice) to consistently achieve the Ahmed-defined C-CDR benchmarks for csPCa (ISUP grade ≥ 2) using UMFB. Both transrectal and transperineal approaches were included to enable comprehensive learning curve analysis. Data from 2017 to 2023 were reviewed, encompassing 157 UMFBs performed by U1 and 242 by U2, with a transrectal-to-perineal ratio of 7:3. Results: Both urologists achieved Ahmed-defined C-CDR targets from the outset. Over a median follow-up of 30 months, patients with initial PI-RADS 4 or 5 ratings and negative primary biopsies remained prostate cancer-free in 77% of cases for U1 and 91.2% for U2 (p = 0.152). Conclusions: This study demonstrates that experienced urologists can achieve high diagnostic accuracy and maintain patient safety immediately upon implementing UMFB, meeting established benchmarks without requiring additional procedural learning.

Certification as a prostate cancer center requires the offer of several supportive measures to patients undergoing radical prostatectomy (RP). However, it remains unclear how patients estimate the relevance of these measures and whether the availability of these measures differs between certified prostate cancer centers (CERTs) and non-certified centers (NCERTs). In 20 German urologic centers, a survey comprising questions on the relevance of 15 supportive measures was sent to 1000 patients at a median of 15 months after RP. Additionally, patients were asked to rate the availability of these measures using a four-item Likert scale. The aim of this study was to compare these ratings between CERTs and NCERTs. The response rate was 75.0%. In total, 480 patients underwent surgery in CERTs, and 270 in NCERTs. Patients rated 6/15 supportive measures as very relevant: preoperative medical counselling concerning treatment options, a preoperative briefing answering last questions, preoperative pelvic floor exercises (PFEs), postoperative PFEs, postoperative social support, and postoperative rehabilitation addressing physical fitness recovery. These ratings showed no significant difference between CERTs and NCERTs (p = 0.133–0.676). In addition, 4/9 of the remaining criteria were rated as more detailed by patients in CERTs. IMPROVE represents the first study worldwide to evaluate a patient-reported assessment of the supportive measures accompanying RP. Pertinent offers vary marginally between CERTs and NCERTs.