Active surveillance (AS) is an established management strategy for men with low- and favorable intermediate-risk prostate cancer (PCa). Nevertheless, a substantial proportion of patients ultimately undergo radical prostatectomy (RP), and the impact of prior AS on subsequent outcomes remains uncertain. We therefore compared surgical methods, adverse pathological findings and post-RP PCa-treatment among men undergoing deferred RP after AS with those of comparable men treated with immediate RP.

Using nationwide data from the Norwegian Prostate Cancer Registry, we identified men diagnosed between 2009 and 2022 with low- or intermediate-risk PCa who underwent deferred RP following AS or immediate RP. Descriptive statistics summarized clinical characteristics and surgical methods. Multivariable logistic regression evaluated adverse pathological findings in the surgical specimen, and Cox proportional hazards models analyzed post-RP PCa-treatment. Kaplan-Meier analyses with log-rank test assessed 10-year PCa-specific survival.

Compared with immediate RP (n = 5767), the deferred RP (n = 1839) group had more unfavorable preoperative tumor characteristics, fewer nerve-sparing procedures and more frequent lymph node dissection. Deferred RP after AS was associated with higher risk of adverse pathological findings (OR 1.99, 95% CI 1.8-2.3) and post-RP PCa-treatment (HR 1.52, 95% CI 1.3-1.8). Ten-year PCa-specific survival did not differ between groups. Limitations include incomplete data on surveillance intensity.

Deferred RP after AS was associated with more extensive surgery, adverse pathological findings and post-RP PCa-treatment, but similar ten-year PCa-specific survival, compared to immediate RP. These findings emphasize the need for surveillance strategies that ensure timely detection of disease progression and transition to radical treatment.

Spinal metastases impose urgent diagnostic and therapeutic demands; however, evidence from low- and middle-income countries (LMICs) in Latin America is sparse. We aimed to characterize real-world practices, access gaps, and priorities to in-form context-adapted guidelines. We conducted a multinational, cross-sectional online survey (September-October 2025) of licensed clinicians managing spinal metastases across 20 Latin American countries. A validated multilingual instrument (60 items; Cronbach's α = 0.87) assessed practice patterns, diagnostic and therapeutic resources, perceived complications and outcomes, and barriers to care. Because this was a clinician-reported survey rather than a patient-level registry, estimates of survival, complications, neurological or ambulatory recovery, length of stay, and reintervention were considered perceptions of local practice and were not interpreted as objective clinical outcomes or measures of treatment effectiveness. A total of 1,318 complete responses were analyzed using descriptive and nonparametric comparative statistics. Respondents were predominantly neurosurgeons (63.4%) and orthopedic spine surgeons (34.3%); most practiced in tertiary centers (88.0%) and managed 10-50 spinal metastasis cases annually (76.6%). Diagnostic capacity was uneven: MRI was the preferred initial study (69.9%), yet round-the-clock availability existed in only 40.5%; advanced imaging was routine in 20.9% and unavailable in 30.1%. Symptom-to-diagnosis intervals were 1-3 months in 56.9% and > 6 months in 13.7%, with longer delays in public and lower-middle-income settings (p ≤ 0.041). Biopsy access was present in 90.9%, but pathology turnaround exceeded two weeks in 26.1%. Surgical access was always selected in 86.3%; open surgery predominated (56.9%), combined approaches 29.4%, and minimally invasive surgery 8.5%. Time-to-surgery exceeded two weeks for 26.8% of cases. Stereotactic body radiotherapy was available in 14.4%, and initiation of radiotherapy occurred > 1 month after indication in 62.7%. Economic cost (46.7%), limited instrumentation (19.7%), and delayed diagnosis (19.1%) were leading barriers. Multidisciplinary tumor boards were routine in 35.3%. Reported survival exceeded one year in 59.3% of practices; common complications included infection (33.8%), implant failure (25.0%), and pulmonary events (22.3%). Standardized outcome scales were used routinely by 79.6%. In Latin America, clinicians demonstrate broad expertise but face systemic constraints (diagnostic delays, restricted advanced imaging/navigation, limited SBRT, and high out-of-pocket costs), that blunt timely, integrated care. Priority actions include accelerating diagnostic pipelines, expanding radiotherapy and navigation assisted capacity, strengthening multidisciplinary pathways, and implementing financial protection. Regionally coordinated registries and targeted training are essential to narrow equity gaps in metastatic spine care.

Accurate diagnosis of acute leukemia (AL) is essential for management. Morphological assessment is used in resource-limited settings, but interpretation can be challenging in ambiguous cases. Flow cytometric immunophenotyping provides diagnostic precision, yet its utility in Yemen remains underreported. This study aimed to assess the concordance between morphological diagnosis and flow cytometric immunophenotyping in newly diagnosed patients at the National Oncology Center, Sana'a, Yemen, and describe discordant cases and antigen-expression patterns. An exploratory prospective cross-sectional diagnostic-agreement study was conducted in July-August 2024. Seventy-five newly diagnosed patients were evaluated using morphology and immunophenotyping. Concordance, antigen expression patterns, discordant cases, and hematological parameters were assessed. By immunophenotyping, 42 patients (56.0%) had precursor acute lymphoblastic leukemia (ALL), 32 (42.7%) had acute myeloid leukemia (AML), and 1 (1.3%) had Burkitt lymphoma/leukemia. For comparative analyses, the Burkitt case was included in the ALL analytical group. The participants included 40 males (53.3%) and 35 females (46.7%), with ages ranging from 8 months to 75 years (mean 24.5 ± 21.2 years). In the analytical groups, children accounted for 69.8% of ALL-group cases, whereas 81.3% of AML cases were adults. The concordance between morphology and immunophenotyping was 89.3%, with κ = 0.79 (95% CI: 0.65-0.93, p < 0.001). Eight cases (10.7%) were discordant, including reclassification of ALL to AML and vice versa. Aberrant antigen expression contributed to misclassification, with examples of CD19 positivity in AML and CD2/CD7 co-expression in AML profiles. Hematological parameters did not differ significantly between AML and ALL, including platelet count (p = 0.084). Morphology demonstrates high agreement with immunophenotyping in the diagnosis of acute leukemia. Flow cytometry supports more precise lineage assignment, particularly in ambiguous cases and those with aberrant markers. Expanding the diagnostic infrastructure and improving access to immunophenotyping may strengthen leukemia diagnosis and care in Yemen, particularly when used as part of an integrated diagnostic approach.

Colorectal cancer (CRC) remains a major cause of cancer incidence and mortality worldwide. Because colonoscopy is resource-intensive and participation is incomplete, non-invasive screening tests are central to population-level prevention. This review synthesizes recent evidence on fecal immunochemical testing (FIT), multi-omics stool DNA-FIT (mt-sDNA-FIT), multi-omics stool RNA-FIT (mt-sRNA-FIT), and blood-based assays, with emphasis on screening of asymptomatic individuals at average risk, the distinction between cancer detection and advanced precancerous lesion detection, and the operational requirements needed to translate test performance into public health benefit. FIT remains the most scalable first-line option in many programs because it is inexpensive, repeatable, and supported by evidence from organized screening. Its performance depends on hemoglobin threshold, sampling and handling, lesion biology, repeated adherence, and colonoscopy completion after a positive result. Molecular stool assays generally improve single-application sensitivity for CRC and advanced precancerous lesions but reduce specificity and increase costs and demand for colonoscopy. Blood-based assays may improve acceptability among people who decline stool testing or colonoscopy; however, current evidence indicates reduced detection of advanced precancerous lesions, limiting their preventive value when used as direct replacements for stool-based strategies. Implementation barriers occur across the screening pathway, including invitation, test access, sample return, laboratory processing, result communication, diagnostic colonoscopy, pathology, treatment access, and registry tracking. Future progress should prioritize risk-adapted screening, validated molecular and multiomics biomarkers, and artificial intelligence-assisted triage, and equitable program design. The most defensible strategy is not universal adoption of a single assay but a resource-stratified pathway that matches screening modality to population risk, patient acceptability, and system capacity.

Clinician experience variability affects lung cancer detection using computed tomography. AI-based computer-aided diagnosis (CAD) systems can improve diagnostic accuracy, but their influence on thoracic surgeons with varying experience is unclear. This study aimed to evaluate the impact of CAD system on thoracic surgeons' assessment of pulmonary nodule malignancy.

A multireader, crossover study included 20 thoracic surgeons (8 junior, 12 senior). Each reader interpreted 100 anonymized pulmonary nodules twice-once with CAD and once without-following a washout period. Nodules were assessed using a 10-point likelihood of malignancy (LOM) scale and a binary (benign/malignant) assessment.

The CAD system demonstrated high malignancy prediction (AUROC = 0.929). CAD assistance significantly improved diagnostic accuracy across all readers (AUROC: 0.770-0.804, p = 0.0014 [BINARY]; 0.833-0.879, p < 0.001 [LOM]). Junior readers showed greater improvement (BINARY: 0.780-0.848, p < 0.001; LOM: 0.838-0.904, p < 0.001) compared with senior readers (BINARY: 0.763-0.775, p = 0.344; LOM: 0.831-0.862, p = 0.026). Specificity significantly increased with CAD (p = 0.008 overall, p < 0.001 junior readers), while sensitivity remained unchanged. Reading time slightly increased with CAD for benign cases (p < 0.05), but remained stable for malignant cases.

The CAD system improved thoracic surgeons' diagnostic performance, especially junior readers, by enhancing specificity and overall accuracy. AI-based CAD systems are beneficial for reducing diagnostic variability and supporting lung nodule malignancy assessment by inexperienced thoracic surgeons.

To describe the clinical profile of girls with central precocious puberty (CPP) and determine the factors associated with abnormal cranial magnetic resonance imaging (MRI) findings.

This retrospective study included girls aged 8 years or younger with a diagnosis of CPP who received care at King Abdullah Specialized Children's Hospital in Riyadh, Kingdom of Saudi Arabia, between 2015 and 2023. Data on clinical presentation, biochemical results, imaging findings, and treatment were obtained from medical records. Logistic regression analysis was performed to determine variables associated with MRI utilization and the occurrence of abnormal MRI findings.

The cohort comprised 70 girls with CPP. The median age at breast development was 7.12 years, and pubertal onset occurred at ≥6 years in 84.3% of patients. Cranial MRI was obtained in 43 patients (61.4%), and abnormal findings were identified in 17 patients (24.3%). Pituitary gland enlargement (n = 6) and hypothalamic hamartoma (n = 4) were the most frequent abnormalities. Girls with a bone age-to-chronological age ratio <1 year had lower odds of undergoing MRI (OR = 0.18, p-value = 0.009). Higher BMI z-scores were independently associated with abnormal MRI findings (OR = 1.95, p-value = 0.043). Other clinical and biochemical variables were not significantly associated with abnormal MRI results. GnRH analogue therapy was initiated in 81.4% of patients.

Abnormal cranial MRI findings were identified in nearly one-quarter of girls with CPP. Higher BMI z-scores were associated with abnormal MRI findings, whereas age at puberty onset and other clinical variables did not reliably predict intracranial abnormalities.

Visceral obesity may affect surgical difficulty in colorectal procedures. While body mass index (BMI) is commonly used to assess obesity, it does not accurately reflect intra-abdominal fat distribution. This study evaluated the impact of visceral fat area (VFA) on perioperative outcomes in robotic-assisted right colectomy.

We retrospectively analyzed consecutive patients undergoing robotic-assisted right colectomy with lymphadenectomy between January 2023 and May 2025. VFA was measured on preoperative computed tomography at the L4 level. Patients were categorized into low-VFA (<100 cm²) and high-VFA (≥100 cm²) groups. Surgical outcomes and lymph node yield were compared.

Sixty-one patients were included, and 29 (47.5%) were classified as high VFA. Lymph node yield was significantly lower in the high-VFA group (P < .001). Operative time, blood loss, and postoperative complications did not differ significantly between groups. Major complications occurred in 6.5% of patients.

Visceral adiposity is associated with reduced lymph node retrieval in robotic-assisted right colectomy, without increasing perioperative morbidity. VFA may serve as a practical indicator of operative complexity.

Immune checkpoint inhibitors have improved outcomes in small-cell lung cancer (SCLC), yet durable benefit remains limited, and the immune consequences of SCLC transformation from EGFR-mutant lung adenocarcinoma (LUAD) remain incompletely understood. Conventional explanations for resistance emphasize PD-L1 expression, tumor mutational burden, T-cell dysfunction, myeloid suppression, and stromal exclusion, but these factors do not fully explain how lineage-state changes alter tumor recognition. Here, we examine lineage plasticity as a potential tumor-cell-intrinsic contributor to immune resistance. We use the term "immune invisibility" narrowly to denote failure of tumor-cell recognition caused primarily by impaired MHC-I antigen processing and presentation. This state is distinguished from immune exclusion and T-cell dysfunction, although the three barriers may coexist. Evidence linking neuroendocrine state to reduced antigen presentation is strongest in primary SCLC and experimental SCLC models. In EGFR-mutant lung adenocarcinoma undergoing SCLC transformation, analogous changes remain biologically plausible but have not been established in paired longitudinal specimens. Therapeutically, checkpoint blockade alone may be insufficient when tumor recognition or T-cell entry is impaired. Clinically established approaches include chemoimmunotherapy in defined SCLC settings and DLL3-directed T-cell engagement in previously treated disease, whereas epigenetic combinations, STING/IFN activation, most antibody-drug conjugates, and cellular therapies remain investigational. Integrating lineage state, antigen-presentation capacity, immune localization, and retained surface targets may provide a framework for distinguishing immune-restoration from immune-redirection strategies.

Extramedullary multiple myeloma is characterized by clonal plasma cell proliferation outside the bone marrow and is associated with an adverse prognosis, particularly when accompanied by high-risk cytogenetic abnormalities. Sinonasal involvement is rare and may present with recurrent epistaxis or unilateral nasal obstruction, creating diagnostic overlap with inflammatory, vascular, lymphoid, and epithelial sinonasal lesions. We report a 54-year-old man with an eight-month history of progressive right-sided nasal obstruction and intermittent epistaxis that became increasingly frequent and refractory to nasal packing. Magnetic resonance imaging showed a right sinonasal mass involving the nasal cavity and maxillary sinus, with septal deviation and no radiological evidence of orbital floor or nasal septal erosion. Endoscopically guided biopsy demonstrated a dense plasma cell infiltrate with mature and atypical forms. Systemic evaluation revealed anemia, multiple lytic skull and humeral lesions, 32% bone marrow plasma cell infiltration, an IgG monoclonal protein with lambda light-chain restriction, and high-risk cytogenetic abnormalities including CKS1B 1q gain, deletion 17p, and deletion 13q. These findings established a diagnosis of high-risk symptomatic multiple myeloma with extramedullary sinonasal involvement rather than a solitary extramedullary plasmacytoma. This case emphasizes that recurrent epistaxis associated with a unilateral sinonasal mass warrants early biopsy and systemic evaluation, particularly when clinical or laboratory features suggest an underlying plasma cell neoplasm.

Lung cancer remains one of the most prevalent and lethal malignancies worldwide and is characterized by a complex tumor microenvironment (TME), including severe hypoxia, acidosis, elevated glutathione levels, and pronounced immunosuppression. These pathological conditions compromise the efficacy of conventional therapies and contribute to drug resistance, tumor recurrence, and metastasis. Nanodynamic therapy (NDT) is an emerging therapeutic paradigm that employs nanomaterials to amplify reactive oxygen species (ROS) generation in response to endogenous or exogenous stimuli, thereby enabling localized tumor ablation and immune reprogramming. This review systematically summarizes the biological basis of NDT in lung cancer. Particular emphasis is placed on the sequential biological processes of TME responsiveness, programmed cell death (PCD) pathway reprogramming, and immune remodeling. We comprehensively review the therapeutic applications and translational potential of four major NDT modalities-sonodynamic therapy (SDT), chemodynamic therapy (CDT), photodynamic therapy (PDT), and radiodynamic therapy (RDT)-in lung cancer. We further highlight recent advances in the integration of these modalities with lung cancer-specific therapeutic strategies. These advances include immunogenic cell death (ICD)-mediated conversion of immunologically "cold" tumors into "hot" tumors, as well as synergistic strategies incorporating EGFR tyrosine kinase inhibitor (EGFR-TKI) therapy, anti-angiogenic treatment, and inhalable pulmonary delivery systems. Finally, we critically examine major barriers to the clinical translation of NDT, including the limited availability of clinically relevant in situ models, inadequate material consistency, insufficient long-term pulmonary toxicity data, and the lack of standardized physical activation parameters. We further propose priorities for future research and clinical translation. Collectively, this review provides a systematic and integrative framework for lung cancer NDT, spanning mechanistic design, therapeutic optimization, and potential clinical translation.