To evaluate whether repeated prostate-specific antigen (PSA) testing influences treatment patterns and healthcare costs for prostate cancer (PCa).

We analyzed a nationwide insurance cohort of men newly registered with PCa from 2010 to 2020. Patients were classified as PSA-tested (≥3 tests across ≥2 years before registration) or PSA non-tested (first PSA test within 3 months before registration). We compared the initial and subsequent treatment patterns between localized and systemic therapies, and per-patient medical expenditures by treatment modality. The analyses focused on 2016 to 2020, when government-set prices stabilized. Primary endpoints were cumulative medical costs and downstream medical utilization patterns.

Of the 166,848 men, 26.7% were PSA-tested, 42.2% were non-tested, and 31.1% were undetermined. Localized therapy was more frequent after repeated testing: surgery, 45.6% versus 33.8% (p<0.001); radiotherapy, 17.0% versus 14.9% (p<0.001); and focal therapy, 0.8% versus 0.3% (p<0.001). Systemic therapy predominated without prior testing: hormone therapy, 59.7% versus 42.3% (p<0.001), chemotherapy, 2.7% versus 1.0% (p<0.001), and androgen receptor-targeted agents, 1.4% versus 0.5% (p<0.001). For localized modalities delivered during 2016 to 2020, the per-patient costs of non-robotic surgery and radiation therapy were comparable between the groups. In contrast, expenditures for hormone therapy and androgen receptor-targeted agents were significantly higher in the PSA non-tested group, primarily reflecting a longer treatment duration rather than higher monthly spending.

Once national prices stabilized, repeated PSA testing was associated with greater use of localized therapy and lower cumulative spending on prolonged systemic treatment without increasing the costs for localized modalities.

Radical cystectomy (RC) is among the most complex procedures in urology, with early morbidity rates exceeding 50%. Understanding which complications occur most often and identifying their predictors may improve perioperative optimization and postoperative surveillance. This study aimed to determine the most common complications occurring within 30 days after RC and to identify their predictors.

We conducted a retrospective observational study of all adult patients undergoing RC with urinary diversion at a single institution between January 2014 and December 2024. A total of 202 patients met inclusion criteria. The seven most frequent complications were identified. Univariable logistic regressions and three separate multivariable models were generated for each complication. Adjusted odds ratios with 95% confidence intervals were reported.

Overall, 53.0% of patients experienced at least one complication within 30 days. The seven most frequent complications were ileus (25.7%), wound complications (18.8%), urinary tract infection (UTI) (18.3%), sepsis (13.4%), evisceration (11.9%), respiratory infection (5.9%), and bowel anastomotic leak (4.5%). Ileus was predicted by intraoperative complications and urinary diversion type. Wound complications were associated with higher Charlson comorbidity index (CCI), sepsis, ileus, and open surgery. Sepsis was predicted by hypertension, advanced-stage disease, ileus, wound complications, and bowel anastomotic leak. No independent predictors were identified for early UTI. Respiratory infection was associated with postoperative ileus. Evisceration was strongly associated with CCI, intraoperative complications, ileus, and bowel anastomotic leak.

Early morbidity after RC remains high. Predictor profiles differed across complications, supporting the need for complication-specific perioperative strategies.

Carcinoma in situ (CIS) of the bladder is a high-grade, non-invasive lesion known to increase the risk of recurrence and progression. However, the prognostic significance of CIS identified at transurethral resection of bladder tumor (TURB) versus radical cystectomy (RC) remains controversial. This study aimed to evaluate the impact of CIS at different treatment stages on recurrence-free survival (RFS) and cancer-specific survival (CSS).

A retrospective multicenter study was conducted using data from 2,553 patients who underwent TURB followed by RC between 2010 and 2019 across eleven Korean institutions. Kaplan-Meier survival curves and Cox proportional hazards models were used to assess the association of CIS at TURB and RC with RFS and CSS, adjusting for clinicopathological variables.

CIS was identified in 731 TURB specimens (28.6%) and 821 RC specimens (32.2%). Patients with CIS at TURB had significantly higher RFS (p<0.001) and CSS (p=0.002) compared to those without. In multivariate analysis, CIS at TURB was independently associated with better RFS (hazard ratio [HR] 0.787, p=0.001) but not CSS (HR 0.989, p=0.905). CIS at RC showed no significant association with either RFS or CSS. Independent predictors of poor survival included advanced stage, lymph node involvement, lymphovascular invasion, and positive surgical margins. Adjuvant therapy was associated with improved CSS.

CIS at TURB is associated with a lower recurrence risk following RC, whereas CIS in RC specimens has limited prognostic impact. These findings suggest CIS at TURB may carry different prognostic implications than traditionally assumed, warranting careful clinical interpretation.

Muscle-invasive bladder cancer (MIBC) is highly aggressive and presents complex treatment challenges. This study aimed to determine if the stage found during the initial transurethral resection of bladder tumor (TURBT) significantly impacts the prognosis of patients undergoing subsequent radical cystectomy (RC).

We retrospectively analyzed a multi-institutional database of 3,258 RC patients treated between January 2010 and December 2019, with confirmed survival data. The analysis included 68 variables such as baseline characteristics, initial and highest TURBT pathology, and final pathology. Patients were categorized into four groups based on initial T stage: pTa, pT1, pT2, and Tis (carcinoma in situ).

The mean follow-up was 46.6±38.7 months. There were no significant differences in demographic variables between the groups. Overall survival (OS) rates differed significantly across the four groups (p=0.017). Crucially, the Tis group demonstrated the most favorable long-term outcomes, with an OS rate over 60% at 150 months. The initial pTa, pT1, and pT2 groups did not show significant OS differences among themselves.

The initial TURBT stage is associated with the prognosis of patients undergoing RC for bladder cancer. Patients with carcinoma in situ (Tis) is associated with more favorable outcomes from earlier cystectomy, leading to markedly improved long-term survival. For patients with more advanced initial stages (pT1, pT2), however, final pathology and lymph node status are more predictive of survival than the initial TURBT findings.

Purpose To determine the interval cancer rate (ICR) after negative screening contrast-enhanced mammography (CEM) and compare the characteristics of interval cancers (ICs) with those of CEM screen-detected cancers. Materials and Methods This retrospective, single-institution study included consecutive screening CEM examinations performed from January 2015 through December 2021. ICs diagnosed within 1 year of a negative screening CEM and all CEM screen-detected cancers were identified. Two breast radiologists independently reviewed prior negative CEM examinations to classify ICs as missed, misinterpreted, or occult. Patient- and lesion-level characteristics were compared between ICs and screen-detected cancers using the Wilcoxon rank sum test for continuous variables and the Fisher exact or χ² tests for categorical variables. Results The study included 6911 screening CEM examinations in 2756 female patients (median age, 53 years; IQR, 47-60 years). Among 6120 negative screening examinations, 14 ICs were diagnosed in 14 patients. The overall ICR was 2.29 cancers per 1000 examinations, and the symptomatic ICR was 0.82 per 1000 examinations (five of 6120). ICs accounted for 13% (14 of 106) of all cancers diagnosed (interval and screen detected). Invasive ICs occurred more frequently in the setting of moderate or marked background parenchymal enhancement than screen-detected cancers (six of eight, 75% vs 17 of 57, 30%; P = .02). Most ICs (10 of 14, 71%) were occult on prior screening CEM. Conclusion The ICR after CEM was 2.29 cancers per 1000 examinations, representing 13% of all cancers diagnosed. Most ICs were occult at prior CEM, and invasive ICs were more frequently associated with moderate or marked background parenchymal enhancement when compared with CEM screen-detected cancers. Keywords: Mammography, Breast, Interval Cancers Supplemental material is available for this article. © RSNA, 2026.

Proton therapy for head-and-neck (HN) cancer offers superior organ-at-risk sparing compared to photon therapy, but is challenged by frequent anatomical changes during treatment. These changes need to be monitored with routine verification CTs (vCTs), which are used to trigger adaptive replans when deemed necessary by the clinical team.

To investigate whether nominal plan robustness evaluation (RE) data-specifically the magnitude and spatial characteristics of high-dose regions (hotspots)-can predict the development of clinically significant hotspots on verification CTs (vCTs) and guide planning strategies that minimize the need for adaptive replanning.

This retrospective study analyzed 46 patients with p16-positive oropharyngeal cancer treated with proton therapy. Clinical treatment plans were robustly evaluated using 12 uncertainty scenarios combining 3 mm setup and ± 3.5% range errors. Each plan was recalculated on periodic vCTs throughout the treatment course to assess plan degradation. The maximum RE hotspot magnitude and location were compared with vCT hotspot characteristics. A subset of five cases underwent proof-of-concept replanning to reduce RE hotspots and assess downstream vCT dose effects.

Patients requiring adaptive replanning due to vCT hotspots had significantly higher RE hotspot magnitudes of the nominal plan compared to those who did not (p = 0.008). For replanned cases, higher RE hotspots were moderately correlated with closer proximity of RE and vCT hotspots (r = -0.59, p = 0.009). Across all patients, a modest correlation (r = 0.58, p < 0.001) was observed between RE and vCT hotspot magnitudes. Further, the rate of plan degradation over the course of treatment via hotspot formation was found to increase with increasing RE hotspot magnitude. Replanning to reduce RE hotspots led to an average 5.6% reduction in vCT hotspot dose for the five patients studied, suggesting that reducing RE hotspots may reduce the frequency of replans.

Nominal plan robustness evaluation is predictive of both the magnitude and location of hotspots observed on vCTs, and plans with higher RE hotspots tend to degrade faster over the treatment course. Minimizing RE hotspots during treatment planning may reduce the need for adaptive replanning and enhance clinical workflow efficiency.

The aim of the study was to compare catheter dislodgement rates between abdominal wall-tunneled femoral peripherally inserted central catheters (PICCs) and conventional upper arm PICCs in pediatric oncology patients.

A retrospective analysis included 355 pediatric oncology patients from Shandong Cancer Hospital (March 2022 to March 2025). Patients were divided into the Tunnel group (abdominal wall-tunneled femoral PICC, n = 145) and Conventional group (upper arm PICC, n = 210). The primary outcome was unplanned catheter dislodgement (external migration >3 cm or complete dislodgement). The Kaplan-Meier method estimated cumulative dislodgement rates; Cox regression identified influencing factors.

The dislodgement rate was 12.41% in the Tunnel group vs 40.95% in the Conventional group (χ2 = 33.727, P < .001). The mean indwelling time was longer in the Tunnel group (181.50 ± 54.72 days vs 114.97 ± 55.84 days; t = -11.165, P < .001). Survival curves showed higher cumulative catheter survival in the Tunnel group (log-rank P < .001).

Abdominal wall-tunneled femoral PICCs significantly reduce dislodgement risk and prolong indwelling time, providing a stable central venous access for pediatric oncology patients requiring long-term therapy.

Brain tumors remain a major clinical challenge, particularly in assessing treatment response after radiotherapy. The aim of this study was to evaluate the effectiveness of noninvasive spectroscopic MRI techniques in monitoring brain tumor response to radiotherapy by analyzing longitudinal changes in metabolic biomarkers.

This observational longitudinal study was conducted from October 1, 2024, to June 1, 2025, in Erbil, Iraq, using purposive sampling. Patients with primary brain tumors who underwent postoperative radiotherapy at Awat Center were included, with MRI and 3D ^1H-magnetic resonance spectroscopy scans performed at Bawan Diagnostic Center at pretreatment, post-treatment, and follow-up stages. Key biomarkers (choline, creatine, N-acetylaspartate, and lactate) and their ratios were analyzed using repeated measures analysis of variance, Bonferroni post hoc tests, receiver operating characteristic analysis, and multivariate logistic regression. Statistical analysis was performed using Stata version 12 (StataCorp LLC, College Station, TX).

A total of 16 patients were included in the study. The most significant biomarker change was a reduction in choline, indicating decreased tumor proliferation across time points. Lactate-to-creatine ratios also declined, reflecting reduced anaerobic metabolism. Receiver operating characteristic analysis identified choline and lactate reductions as the most predictive indicators of treatment response. The final regression model showed that higher Karnofsky Performance Status was significantly associated with better treatment outcomes. Biomarker-driven risk stratification further supported clinical decision making by identifying thresholds for continued therapy versus reassessment.

Noninvasive spectroscopic MRI techniques proved effective in detecting metabolic changes in brain tumors after radiotherapy, especially reductions in choline and lactate, which were associated with clinical treatment response. Based on these findings, policymakers and healthcare providers are encouraged to integrate magnetic resonance spectroscopy into routine neuro-oncology imaging protocols and support specialized training for radiologists.

Stereotactic body radiotherapy (SBRT) is the standard treatment for medically inoperable early-stage, non-small-cell lung cancer (NSCLC). Programmed death-ligand 1 (PD-L1) is a well-known biomarker for predicting immunotherapy responses; however, its prognostic significance in early-stage NSCLC treated with SBRT remains unclear. Here, we evaluated the prognostic significance of PD-L1 expression in this setting.

We retrospectively analyzed patients with early-stage NSCLC who underwent SBRT. PD-L1 expression was assessed using the SP263 immunohistochemistry assay and quantified by tumor proportion score. We evaluated the prognostic impact of PD-L1 as a continuous variable and used an exploratory 2% cutoff derived from receiver operating characteristic analysis. Clinical outcomes, including local recurrence-free survival (LRFS), recurrence-free survival (RFS), disease-free survival (DFS), and overall survival (OS), were compared. Cox proportional hazards models were used for multivariable analysis.

A total of 54 patients were included. SBRT achieved a 2-year LRFS rate of 98%. As a continuous variable, higher PD-L1 expression was independently associated with inferior RFS (hazard ratio (HR): 1.07, p < 0.01), DFS (HR: 1.06, p < 0.01), and OS (HR: 1.04, p < 0.01). The PD-L1-positive group had a higher incidence of regional recurrence (30.0% vs. 5.9%, p = 0.041). The exploratory 2% cutoff identified a subgroup with significantly worse survival in univariable analyses, although it did not retain independent significance in the multivariable analysis.

PD-L1 expression is independently associated with worse survival outcomes in patients with early-stage NSCLC treated with SBRT, indicating its potential as a prognostic biomarker for risk stratification.

This observational study was designed to establish and validate a stigma prediction model for patients with polycystic ovary syndrome (PCOS). The stigma risk scoring table for overweight and obese patients with PCOS has good predictive ability. When an overweight or obese patient with PCOS presents, the prediction model allows clinic staff to rapidly grade hirsutism, acne, and acanthosis, determine fertility desire, and quantify anxiety. Low-risk patients then receive standard care, whereas high-risk patients receive precision interventions. Unlike the traditional approach, this clinical prediction model incorporates not only laboratory values but also body-image concerns and psychological well-being, providing more comprehensive management for women with PCOS. To preliminarily explore the associations among stigma, PCOS signs, anxiety, and depression. A total of 124 overweight and obese patients with PCOS were selected using convenience sampling. The patients in the order of clinic visit time were divided into a modeling set and a validation set at a ratio of 3:1. Univariate analysis was first performed, normally distributed continuous variables were compared using t-tests, non-normally distributed continuous variables with nonparametric rank-sum tests, and categorical variables with χ2 tests. Independent risk factors for stigma were identified using multivariable logistic regression, and a nomogram was constructed. The model's discrimination and calibration were evaluated with the receiver operating characteristic curve and calibration curve. Internal validation was subsequently conducted on the validation data set to assess model performance comprehensively. Hirsutism (odds ratio [OR]=0.075, 95%Cl: 0.015-0.368) , acne (OR=0.210, 95%Cl: 0.050-0.878) , acanthosis nigricans (OR=0.184, 95%Cl: 0.044-0.073) , fertility requirements (OR=0.212, 95%Cl: 0.051-0.890) , and anxiety (OR=1.217, 95%Cl: 1.074-1.378) were independent influencing factors for stigma in these patients (P < .05). The constructed prediction model also demonstrated good predictive ability, with area under the curve values of 0.941 and 0.803 for the modeling and validation sets, respectively. Internal validation using 1000 bootstrap resamples revealed a mean area under the receiver operating characteristic curve area under the curve of 0.941.