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A randomized trial involving patients with metastatic prostate cancer whose disease progressed after receipt of docetaxel and hormonal therapy showed that cabazitaxel was superior to an androgen-signaling–targeted agent in extending imaging-based progression-free survival, overall survival, and PSA response.

Background/Objectives: Retroperitoneal lymph node dissection (RPLND) plays a crucial role in the staging and treatment of testicular cancer and is often mandatory. RPLND is associated with a high risk of morbidity. The use of minimally invasive techniques has significantly increased the number of robotic procedures performed over the last few years. This study aimed to analyze the perioperative and postoperative outcomes and trends of an increasing number of surgeries performed. Materials and Methods: We retrospectively analyzed 30 robotic RPLNDs (R-RPLNDs) performed at our testicular cancer center between 2020 and 2024. Logistic regression analyses were used to analyze the independent variables of operative time (OT), hospital stay (HS), estimated blood loss, lymph node yield, and complications according to the Clavien–Dindo classification system. The independent predictors included case number, clinical stage, post-chemotherapy status, preoperative retroperitoneal tumor mass, and body mass index. Furthermore, the patients were categorized into three groups: group A (cases 1–10), group B (cases 11–20), and group C (cases 21–30). A Kruskal–Wallis test was performed to assess differences among the groups concerning OT, HS, and lymph node yield. Results: OT significantly decreased with an increasing number of cases (p < 0.001), and HS was significantly affected by overall complications (p = 0.0006). There were two major perioperative complications (6.6%). No factors predicted overall complications or Clavien–Dindo grades I-II or III–V. The Kruskal–Wallis test showed a significant difference (p < 0.05) in OT and HS for group C. Conclusions: R-RPLND for GCTs demonstrates a clear learning curve, with significant improvements in OT, HS, and complication rates as surgeons gain experience. Overall, the low complication rates for R-RPLND did not indicate predictive factors for perioperative or postoperative complications. RPLND presents promising potential as a safe and effective treatment for GCTs, especially when performed by experienced surgeons in specialized centers.

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.

Background/Purpose: Retroperitoneal lymph node dissection (RPLND) plays a crucial role in the surgical management of testicular cancer. However, RPLND is associated with a high risk of morbidity. Currently, open RPLND (O-RPLND) is considered the gold standard for surgical treatment. The use of minimally invasive techniques has increased significantly over the last few years. This study aimed to compare the safety and oncological outcomes of open (O-RPLND) and robotic (R-RPLND) retroperitoneal lymph node dissection for testicular cancer. Materials and Methods: We retrospectively analyzed all the patients who underwent RPLND at our testicular cancer center. Standard O-RPLND was performed with the usual equipment, and R-RPLND was performed with the Da Vinci X/Xi surgical system. The pre- and perioperative parameters and the postoperative complications (Clavien–Dindo classification), anejaculation, and the relapse rate were recorded. The association between the clinicopathological variables and the complications and relapse was assessed using regression analyses. Results: Sixty-five patients underwent RPLND during 2017–2024 due to testicular cancer (TC), with thirty-one (47.7%) receiving R-RPLND, including seventeen patients post-chemotherapy (55%). Meanwhile, 34 (52.3%) underwent O-RPLND, comprising 31 patients post-chemotherapy (91%). R-RPLND demonstrated excellent results compared to O-RPLND in terms of the operative time (OT) (p < 0.00001). The R-RPLND group had two (6.5%) high-grade (Clavien–Dindo III–V) complications, while four (11.8%) high-grade complications were noted in the O-RPLND group. R-RPLND was linked to a shorter OT (p < 0.00001). The hospital stay for R-RPLND was, on average, 2.7 days shorter. In logistic regression analysis, R-RPLND was non-inferior to O-RPLND for overall complications (p = 0.6) and low-grade Clavien–Dindo (I-II) (p = 0.2) and high-grade Clavien–Dindo (≥III) complications (p = 0.7). The median follow-up was 13 months for R-RPLND and 38 months for O-RPLND. Two relapses were observed in the R-RPLND group (6.5%), and two in the O-RPLND group (5.9%). One patient who underwent R-RPLND developed field-edge recurrence. No significant differences in the relapse and anejaculation rates were found between R-RPLND and O-RPLND (p = 0.9 and p = 0.8, respectively). Conclusions: In conclusion, R-RPLND is a feasible procedure with a low complication rate and an acceptable oncological outcome. It has proven to be significantly shorter to O-RPLND in relation to the lengths of HS and OT. However, R-RPLND is a demanding procedure with a considerable learning curve.

The pathogenesis of testicular germ cell tumours (GCTs) is still incompletely understood. Any progress in its understanding must derive from observational studies. Recently, it has been suggested that the incidence of GCTs may follow a seasonal pattern based on circannual changes in the Vitamin D serum levels, with maximum incidence rates in winter months. To examine this promising hypothesis, we studied monthly incidence rates of testicular GCTs in Germany by analysing 30,988 GCT cases aged 15–69 years, diagnosed during 2009–2019. Monthly incident case numbers with data regarding histology and patient age were obtained from the Robert Koch Institut, Berlin, along with annual male population counts. We used precision weighting for deriving pooled monthly incidence rates for GCTs of the period 2009–2019. We stratified pooled rates by histology (seminoma and nonseminoma) and age (15–39 and 40–69 years). By assuming a cyclical effect, we used an estimator of the intensity of seasonal occurrence and report seasonal relative risks (RR). The mean monthly incidence rate was 11.93/10 5 person-months. The seasonal RR for testicular cancer over-all is 1.022 (95% CI 1.000–1.054). The highest seasonal RR was found in the subgroup of nonseminoma aged 15–39 years, with a RR 1.044 (95% CI 1.000–1.112). The comparison of the pooled monthly rates of the winter months (October—March) with the summer months (April-September) revealed a maximum relative difference of 5% (95% CI 1–10%) for nonseminoma, aged 15–39 years. We conclude that there is no evidence of a seasonal variation of incidence rates of testicular cancer. Our results are at odds with an Austrian study, but the present data appear sound because the results were obtained with precision weighted monthly incidence rates in a large population of GCT cases.

Purpose microRNA-371a-3p (M371) is considered a highly sensitive and specific serum biomarker of testicular germ cell tumours (GCTs). However, little is known about the expression of M371 in nontesticular malignancies (NTMs), so far. As knowledge about the expression of the marker in other malignancies is a prerequisite for the clinical application of the test we aimed to explore the M371 expression in other cancers. Methods M371 serum levels were measured in 137 patients with NTM of 12 different neoplastic entities using the IVDR-certified M371-Test for quantitative real-time PCR. Median M371 serum levels and percentages of M371 level elevations were calculated for the entire NTM group and for entity-specific subgroups. The results were compared with GCT patients ( n  = 20) and with tumour-free male controls ( n  = 20) using descriptive statistical methods. Results Eight patients with NTMs had M371 serum level elevations, corresponding to a false-positive rate (FPR) of 5.84% (95% confidence intervals (CIs) 2.55–11.18%). Expression rates in GCTs and controls were 100% and zero, respectively. Thus, the specificity of the M371-Test for GCT is 94.90% (95% CI 90.21–97.77%) when all NTMs and tumour-free controls are considered. Remarkably, three out of 5 patients with multiple myeloma had elevated M371 levels. Conclusion The false-positive rate of the M371-Test in other malignancies than GCT is very low, and almost identical with that in healthy males, corresponding to a high specificity of 94.9% for detection of GCT. The surprising finding of M371 elevations in patients with multiple myeloma needs further investigation.

Testicular germ cell tumor (GCT) is a rare disease, accounting for no more than 1.5% of all neoplasms in males, but represents the most common tumors in adolescents and young men in Western countries. There is also consensus about the involvement of genetic factors in the etiology of testicular GCT. Familial occurrence of testicular GCT is observed in 1-2% of all cases with GCT. We report the unique case of two brothers, both afflicted with inherited Emery-Dreifuss muscular dystrophy (EDMD) and both developing testicular GCT in young adulthood. EDMD is a rare muscular dystrophy, characterized by the triad of joint contractures, slowly progressive muscle weakness, and cardiac involvement. EDMD is not a homogeneous clinical entity because it is associated with various gene mutations. One common mutation relates to the Four and a half Limb domain protein 1 (FHL-1) gene. To date, there have been no GCT cases linked with FHL-1 mutations and no malignant disease has been found associated with EDMD.

Background Sex cord gonadal stromal tumors compose less than 10% of all testicular neoplasms and consist of a variety of histological subtypes. In 2016, the World Health Organization introduced a novel subtype, the myoid gonadal stromal tumor, that consists of spindle-shaped cells with immunohistologic features of muscle cells. Only few cases have been reported to date. Due to its rarity and owing to its only recent introduction, the current knowledge about myoid gonadal stromal tumor is limited, and particularly, appropriate clinical management is still ill-defined. Case presentation A 47-year-old man of Caucasian descent presented with nonspecific scrotal discomfort. A roundish and well demarcated hypoechoic mass of 8.5 mm in diameter was detected in the cranial region of the left testis. Serum tumor marker levels were within normal ranges. Testis-sparing surgery revealed a 9-mm whitish, hard mass with sharp surgical margin. Histologically, the neoplasm consisted of microfibrillar tissue with spindle-shaped cells harboring elongated nuclei. Immunohistochemical work-up disclosed expression of desmin, small muscle actin, and S100 protein giving evidence for the myogenic nature of the neoplastic cells. There was no indication of malignancy, neither histologically nor clinically. Follow-up of 1 year was uneventful. Conclusion A literature survey revealed 22 previous cases of myoid gonadal stromal tumor. The median age was 37 years, the median size of the neoplasm was 20 mm, and there was no side-preponderance. Myoid gonadal stromal tumor is not much different from other subtypes of gonadal stromal tumors nor from testicular gem cell tumors regarding age and laterality; however, tumor size is smaller in myoid gonadal stromal tumors than in germ cell tumors. Although rarely performed so far, testis-sparing surgery probably constitutes an appropriate treatment of this neoplasm. Myoid gonadal stromal tumor represents an emerging novel entity of benign testicular new growths that caregivers of patients with testicular tumors should be aware of.

PurposeLymphovascular invasion (LV1) and presence of > 50% embryonal carcinoma (> 50% EC) represent risk factors for progression in patients with clinical stage 1 (CS1) nonseminomatous (NS) testicular germ cell tumours. As serum levels of microRNA-371a-3p (M371) are capable of detecting small amounts of GCT, we evaluated if LV1 and > 50% EC are associated with M371 levels.MethodsM371 serum levels were measured postoperatively in 153 NS CS1 patients and both pre- and postoperatively in 131 patients. We registered the following factors: age, tumour size, LV status, > 50% EC, teratoma in primary, preoperative elevation of classical tumour markers. M371 expression was compared among subgroups. The ability of M371 to predict LV1 was calculated by receiver operating characteristics (ROC) curves. Multiple regression analysis was used to look for associations of M371 levels with other factors.ResultsPostoperatively elevated M371 levels were found in 29.4% of the patients, but were neither associated with LV status nor with > 50% EC. Likewise, relative decrease of M371 was not associated. ROC analysis of postoperative M371 levels revealed an AUC of 0.5 for the ability to predict LV1 while preoperative M371 had an AUC of 0.732. Multiple regression analysis revealed significant associations of preoperative M371 levels with LV status (p = 0.003), tumour size (p = 0.001), > 50% EC (p = 0.004), and teratoma component (p = 0.045).ConclusionPostoperatively elevated M371 levels are not associated with risk factors for progression in NS CS1 patients. However, the significant association of preoperative M371 expression with LV1 deserves further evaluation.

After the outbreak of COVID-19 unprecedented changes in the healthcare systems worldwide were necessary resulting in a reduction of urological capacities with postponements of consultations and surgeries. An email was sent to 66 urological hospitals with focus on robotic surgery (RS) including a link to a questionnaire (e.g. bed/staff capacity, surgical caseload, protection measures during RS) that covered three time points: a representative baseline week prior to COVID-19, the week of March 16th-22nd and April 20th-26th 2020. The results were evaluated using descriptive analyses. 27 out of 66 questionnaires were analyzed (response rate: 41%). We found a decrease of 11% in hospital beds and 25% in OR capacity with equal reductions for endourological, open and robotic procedures. Primary surgical treatment of urolithiasis and benign prostate syndrome (BPS) but also of testicular and penile cancer dropped by at least 50% while the decrease of surgeries for prostate, renal and urothelial cancer (TUR-B and cystectomies) ranged from 15 to 37%. The use of personal protection equipment (PPE), screening of staff and patients and protection during RS was unevenly distributed in the different centers-however, the number of COVID-19 patients and urologists did not reach double digits. The German urological landscape has changed since the outbreak of COVID-19 with a significant shift of high priority surgeries but also continuation of elective surgical treatments. While screening and staff protection is employed heterogeneously, the number of infected German urologists stays low.