To date, no head-to-head comparisons of apalutamide versus darolutamide have been reported for metastatic castration-sensitive prostate cancer (mCSPC). This study compared prostate-specific antigen decline ≥ 90% (PSA90) and overall survival (OS) between apalutamide and darolutamide, both without docetaxel, among patients with mCSPC in real-world clinical practice in the USA.

Men diagnosed with mCSPC who initiated apalutamide or darolutamide between 2022 and 2025 were identified from linked electronic medical records and insurance claims. The apalutamide and darolutamide cohorts were balanced using inverse probability of treatment weighting. PSA90 response was assessed on-treatment. The proportions of patients achieving a PSA90 response and OS through a maximum of 6 months and 24 months post-treatment initiation, respectively, were compared between the two cohorts using weighted Kaplan-Meier and weighted Cox proportional hazards models.

For PSA90 analyses, weighted characteristics were well balanced between the apalutamide (n = 714; mean age 73.9 years, 59.6% White, 21.2% Black, 13.7% other, 5.5% unknown race) and darolutamide cohorts (n = 145; mean age 74.3 years, 58.8% White, 21.6% Black, 15.0% other, 4.7% unknown race). PSA90 response rates through 6 months were 49% higher for apalutamide than for darolutamide (weighted hazard ratio [HR]: 1.49 [95% confidence interval (CI) 1.07, 2.07]; p = 0.017). For OS analyses, weighted characteristics were also well balanced between apalutamide (n = 1460; mean age 73.5 years, 59.6% White, 21.5% Black, 13.5% other, 5.4% unknown race) and darolutamide (n = 287; mean age 73.7 years, 60.0% White, 22.4% Black, 12.4% other, 5.2% unknown race). Apalutamide was associated with a 51% lower rate of mortality relative to darolutamide through 24 months (weighted HR: 0.49 [95% CI 0.30, 0.83]; p = 0.007).

Among patients with mCSPC treated without docetaxel, apalutamide was associated with higher PSA90 response rates and lower mortality than darolutamide. These findings indicate a potential difference in disease control and survival between the two androgen receptor-targeted agents in routine clinical practice.

Tumor-to-tumor metastasis (TTM) is a rare clinicopathological phenomenon in which a malignant tumor metastasizes to another distinct neoplasm. Although renal cell carcinoma (RCC) is a frequent recipient tumor, metastasis from breast carcinoma to RCC is extremely rare. A 64-year-old woman with long-standing hormone receptor-positive breast carcinoma presented with a 23-mm enhancing right renal mass. Robot-assisted partial nephrectomy revealed clear cell RCC with intratumoral nests of metastatic breast carcinoma. Immunohistochemistry revealed a reciprocal staining profile: RCC cells were positive for PAX8 and CA9, whereas metastatic breast carcinoma cells expressed CK7 and GATA3 with weak ER positivity. Clear cell RCC may serve as a recipient tumor for breast carcinoma metastasis, emphasizing that TTM should be considered in the differential diagnosis of renal masses in patients with a history of breast carcinoma, even when imaging findings are consistent with conventional RCC.

To describe the clinical and tumor characteristics of bladder leiomyoma (BL) and to explore potential etiological factors and prognostic factors to guide management strategies.

Patients with histologically confirmed BL treated at 14 hospitals between 1995 and 2025 were included. Associations between tumor characteristics, symptoms, management, and outcomes were evaluated using appropriate statistical tests and logistic regression. A p-value < 0.05 was considered significant.

Among 74 patients (55.4% female, median age 60 years [IQR, 42.25-70.00]), 48.6% were asymptomatic at diagnosis, and 66.2% presented with at least one metabolic syndrome criterion. Tumors had a median size of 21.0 mm [IQR 13.50-35.00] and were most frequently endovesical (48.6%), followed by intramural (35.1%) and extravesical (16.2%) patterns; tumor size and location were not associated with preoperative symptoms but significantly influenced surgical management (p = 0.002). Transurethral bladder resection was the most common treatment (62.2%), followed by partial cystectomy (23.0%) and bladder excision (9.5%), with 68.8% of them performed laparoscopically. Early postoperative complications occurred in 8.1% of patients. Over a median follow-up of 14.3 months [IQR 2.3-48.0], recurrence occurred in 5.4% and persistent or worsening symptoms in 17.6% of patients. Initial LUTS were predictive of both recurrence and persistent postoperative symptoms (OR = 2.02 [1.20-4.61] and 2.38 [1.53-4.55], respectively).

This study represents the largest cohort of BL to date. The high proportion of asymptomatic cases suggests that its true incidence is underestimated. While recurrence was uncommon, persistent LUTS remained a concern among initially symptomatic patients, supporting a personalized, conservative therapeutic approach whenever feasible. Further studies are needed to clarify the biological mechanisms underlying BL and to optimize its management.

To evaluate the prevalence and clinical relevance of incidental findings detected during pancreatic cyst surveillance and explore their implications for pancreas-focused imaging protocols.

This single-center retrospective study analyzed abdominal MRI and CT reports for pancreatic cyst surveillance (2005-2025) using a large language model (LLM). Incidental findings were findings unrelated to the clinical indication. Only the earliest surveillance examination per patient was included. Patients were stratified into cyst-only surveillance (cyst-only), cyst surveillance with high-risk pancreatic screening (cyst-HRI), or cyst surveillance with additional clinical indications (cyst-other). Electronic health record (EHR) review evaluated suspected extrapancreatic neoplastic incidental findings and incidental intrapancreatic hyperenhancing lesions. LLM performance was validated against two reviewers in 100 sampled reports. Multivariable logistic regression adjusted for age and sex.

6174 patients (mean age, 70.6 ± 12.3 years; 65.7% women) were included; 94.8% underwent MRI. LLM-reviewer agreement was high (Cohen κ = 0.857 and 0.882). Incidental findings were identified in 43.0% of examinations and were predominantly nonneoplastic (98.7%), with most not requiring further action (70.2%). EHR targeted review confirmed 19 extrapancreatic neoplasms, most commonly renal neoplasms (n = 14). Extrapancreatic neoplasms were more frequent in cyst-other than cyst-only patients (14/906 [1.55%] vs. 5/4,822 [0.10%]; aOR, 14.20; 95% CI 5.09-39.61; p < 0.001). No extrapancreatic neoplasms were identified in cyst-HRI patients (0/446; 95% CI 0.00-0.82%). Incidentally detected intrapancreatic hyperenhancing lesions were uncommon (31/6,174, 0.50%); final diagnoses included 25 neuroendocrine tumors and four intrapancreatic splenules.

Clinically significant extrapancreatic neoplasms were rare during pancreatic cyst surveillance, particularly among cyst-only and cyst-HRI patients. While this study did not directly assess the diagnostic performance of reduced field-of-view or non-contrast MRI, the low burden of extrapancreatic neoplasms suggests these protocol strategies warrant further evaluation in selected populations.

Colorectal cancer is the fourth most common cancer and the second most common cause of cancer deaths in England. Most cases of colorectal cancer arise from a prior adenomatous polyp in the bowel lining. Colonoscopy is the gold standard investigation for people with symptoms suggestive of colorectal cancer. During a colonoscopy, polyps can be removed or a biopsy can be taken. However, waiting times for colonoscopy can be long and the procedure can be unpleasant. Colon capsule endoscopy may provide an alternative diagnostic procedure to rule out polyps or colorectal cancer.

To evaluate the clinical effectiveness, acceptability and cost-effectiveness of colon capsule endoscopy using PillCam COLON 2 for detecting colorectal polyps and colorectal cancer.

A systematic review searched six bibliographic databases and eight conference proceedings in August 2024. Studies of PillCam COLON 2 in symptomatic or polyp surveillance patients were included if they were randomised controlled trials, or if they reported data on diagnostic test accuracy, yield or patient preference. Bayesian pooling of sensitivity and specificity was performed. The economic analysis included a review of existing models and development of an independent model to assess the cost-effectiveness of colon capsule endoscopy versus colonoscopy and computed tomography colonography in three main populations (symptomatic patients with a faecal immunochemical test score of 10-100 μg/g, symptomatic faecal immunochemical test < 10 μg/g and surveillance patients). Subgroup analyses were conducted in patients who are able and willing to undergo colonoscopy and those who are not (denoted 'COL-eligible' and 'COL-ineligible').

Among the diagnostic test accuracy studies (11-64% patients 'in-scope'), for polyps of any size (two studies), ≥ 6 mm (four studies) and ≥ 10 mm (four studies), pooled sensitivities were 0.78 (95% credible interval 0.51 to 0.90), 0.83 (95% credible interval 0.70 to 0.91) and 0.85 (95% credible interval 0.70 to 0.94), respectively. Specificities were 0.60 (95% credible interval 0.27 to 0.88), 0.69 (95% credible interval 0.52 to 0.81) and 0.90 (95% credible interval 0.82 to 0.95), respectively. Among yield studies, colonoscopy was spared in 37-50% of symptomatic patients (three studies). Data on colonoscopy spared in surveillance patients were available from one study; however, these data are confidential and cannot be reported here. In patients unwilling/unable to undergo colonoscopy, colon capsule endoscopy completed 70-98% of incomplete colonoscopies. Patient preference studies indicated general satisfaction with PillCam COLON 2, but some conflicting information on patient preference for colon capsule endoscopy compared to colonoscopy and computed tomography colonography. For colonoscopy-eligible patients, within all three main analysis populations, the External Assessment Group's model suggests that colon capsule endoscopy is expected to lead to small quality-adjusted life-year losses and higher costs than colonoscopy; hence, colon capsule endoscopy is dominated by colonoscopy. For colonoscopy-ineligible patients, colon capsule endoscopy either dominated by computed tomography colonography or has an incremental cost-effectiveness ratio which is markedly higher than £30,000 per quality-adjusted life-year gained. Despite these findings, colon capsule endoscopy is predicted to lead to substantial reductions in the number of colonoscopies required, particularly for symptomatic patients who are able to undergo colonoscopy.

The generalisability of the diagnostic test accuracy data to symptomatic and polyp surveillance patients was unclear.

Colon capsule endoscopy is expected to be less effective and more expensive than colonoscopy. However, it could help to free up constrained colonoscopy services, particularly in people with symptoms suggestive of bowel cancer.

The systematic review protocol is available on the PROSPERO website (registration number CRD42024586405).

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR136010) and is published in full in Health Technology Assessment; Vol. 30, No. 58. See the NIHR Funding and Awards website for further award information.

Accurate non-invasive assessment of cutaneous lesions requires integration of diagnostic information with real-world management outcomes. Reflectance confocal microscopy (RCM) is increasingly used as a second-level tool after dermoscopy, but evidence linking diagnostic agreement, histological verification, and management across melanocytic and non-melanocytic lesions remains limited.

This retrospective observational study included 886 patients with 1057 cutaneous lesions evaluated by combined dermoscopy and RCM at a tertiary referral center between October 2023 and September 2024. Lesions were classified as benign melanocytic, malignant melanocytic, benign non-melanocytic, or malignant non-melanocytic. RCM-dermoscopy agreement was assessed using observed agreement and Cohen's kappa; chi-square testing evaluated diagnostic association. Histology-based performance analyses were restricted to histologically confirmed lesions.

Among 931 lesions with both classifications available, observed agreement was 37.8%, with fair agreement by Cohen's kappa (κ = 0.211; 95% confidence interval [CI], 0.172-0.251). Diagnostic distributions were significantly associated (χ² = 571.3, df = 9, p < 0.001), with substantial discordance, particularly within melanocytic categories. Histopathological confirmation was available for 225 lesions (21.3%), indicating verification bias. In the dedicated melanocytic excision subset, 162 excised lesions yielded 41 melanomas, resulting in a numbers needed to excise (NNE) value of 3.95. Malignant non-melanocytic detection yield was 39.0% among histologically confirmed excised non-melanocytic lesions.

In this real-world tertiary referral cohort, RCM integrated with dermoscopy supported lesion stratification and management across diagnostic categories. The significant association but fair agreement between modalities highlights their complementary role. Diagnostic performance estimates should be interpreted within the histology-confirmed subset and in light of verification bias.

World Health Organization (WHO) grade 2 and 3 meningiomas are aggressive neoplasms characterized by high postoperative recurrence rates and unfavorable prognoses. Despite advances in surgical and radiotherapeutic management, effective systemic treatment options for recurrent WHO grade 2/3 meningiomas remain limited, with most therapies still under clinical investigation.

To evaluate the efficacy and safety of various pharmacological treatment strategies for recurrent high-grade meningioma, including conventional chemotherapy, targeted therapy, and immunotherapy.

A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and ClinicalTrials.gov from database inception to August 2025. Relevant studies investigating conventional chemotherapy, targeted therapy, and immunotherapy for recurrent high-grade meningioma were systematically reviewed to summarize current advances in precision therapeutic strategies.

Conventional cytotoxic chemotherapy has demonstrated limited survival benefit in recurrent high-grade meningioma and is primarily used for palliative symptom management. In contrast, molecular targeted therapies have shown varying degrees of anti-tumor activity, including anti-angiogenic agents, Tyrosine Kinase Inhibitors (TKI), Focal Adhesion Kinase (FAK) inhibitors, and Mammalian Target of Rapamycin (mTOR) inhibitors. Among these, Bevacizumab demonstrated relatively favorable efficacy, prolonging median progression-free survival to 12-18 months in phase II clinical studies. Immunotherapy has also emerged as a promising therapeutic approach. Programmed death-1 (PD-1) inhibitors achieved 6-month progression-free survival rates (PFS-6) of up to 48% in early clinical studies. Furthermore, emerging immunotherapeutic strategies, such as chimeric antigen receptor T-cell (CAR-T) therapy, oncolytic virus (OVs) therapy, and personalized tumor vaccines, have demonstrated preliminary therapeutic potential. Nevertheless, developing standardized treatment strategies remains challenging due to limited clinical trial sample sizes, methodological heterogeneity, and substantial intertumoral and intratumoral molecular variability.

Future research should prioritize molecular subtype-based therapeutic strategies to facilitate personalized treatment according to tumor biology. In addition, combination regimens integrating targeted therapy and immunotherapy may further improve therapeutic response and quality of life in patients with recurrent high-grade meningioma.

Background/Objectives:BCR::ABL1-negative myeloproliferative neoplasms (MPNs), including essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF), are clonal hematopoietic stem cell disorders characterized by chronic systemic inflammation and elevated thrombotic risk. Osteoarthritis (OA), the most prevalent joint disease globally, is common in MPNs and shares a common proinflammatory cytokine milieu with MPNs. However, whether symptomatic OA may independently impact MPN-related symptom burden and thrombotic outcomes remains unexplored. Methods: In this prospective two-center study conducted in Croatia (2021-2023), 107 consecutive MPN patients diagnosed by 2016 World Health Organization criteria underwent orthopedic evaluation and completed the MPN Symptom Assessment Form (MPN-SAF) at enrolment. Symptomatic OA was defined as radiographic grade ≥1 (Kellgren-Lawrence) with concordant symptoms. Patients were subsequently followed for thrombotic events. Multiple linear regression and Cox proportional hazards regression were used for multivariable analyses. Results: Symptomatic OA was identified in 64 patients (59.8%). The total symptom score (TSS) was significantly higher in OA patients (p < 0.001), and in multivariable analysis, OA independently predicted higher TSS (β 10.12, 95% confidence interval-CI 5.38-14.86, p < 0.001), alongside female sex and arterial hypertension. Over a median follow-up of 44 months, 10 thrombotic events occurred. Patients with symptomatic OA had significantly worse time to thrombosis (hazard ratio-HR 3.61, 95% CI 1.02-12.8, p = 0.046). In multivariable Cox regression, OA remained associated with thrombosis (HR 15.55, p = 0.002), while female sex (HR 0.17, p = 0.042) and aspirin use (HR 0.15, p = 0.019) were protective. Conclusions: Symptomatic OA may be associated with higher symptom burden and, in this preliminary analysis, with higher thrombotic risk in MPNs. These findings support systematic OA evaluation in MPNs and multidisciplinary management strategies targeting this frequent and burdensome comorbidity.

Background and Objectives: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is an emerging minimally invasive therapeutic option for pancreatic and selected extra-pancreatic lesions. However, its clinical adoption is limited by heterogeneous indications, non-standardized techniques, and variable quality of evidence. This systematic review assessed the published literature on EUS-RFA and classified available evidence according to the Oxford Centre for Evidence-Based Medicine levels of evidence. Materials and Methods: A systematic search was performed to identify peer-reviewed studies reporting clinical or translational data on EUS-RFA. Studies were grouped by indication, including pancreatic insulinoma, non-functioning pancreatic neuroendocrine neoplasms, branch-duct intraductal papillary mucinous neoplasms and other pancreatic cystic neoplasms, pancreatic ductal adenocarcinoma, pancreatic metastases, adrenal adenoma, and miscellaneous indications. Each study was categorized according to Oxford level of evidence based on study design. Results: Thirty-seven records were included in the final evidence map, comprising 36 clinical studies classifiable according to Oxford levels of evidence and one translational record not classifiable as clinical therapeutic evidence. Among the 36 clinically classifiable studies, one provided Level 1b evidence, consisting of a randomized trial evaluating EUS-guided celiac ganglion RFA for pancreatic cancer-related pain palliation, and three provided Level 2b evidence, including non-randomized comparative cohorts in pancreatic insulinoma and unresectable pancreatic ductal adenocarcinoma. Most clinically classifiable studies were Level 4 evidence (32/36), mainly uncontrolled prospective or retrospective cohorts and case series. One preclinical/translational study was not classifiable within clinical therapeutic evidence levels. Pancreatic insulinoma was the most evidence-supported tumor-ablation indication, with comparative data suggesting efficacy comparable to surgery and a more favorable safety profile. For non-functioning pancreatic neuroendocrine neoplasms, branch-duct IPMN, renal cell carcinoma pancreatic metastases, and adrenal adenomas, available data suggest feasibility and encouraging short-term outcomes but remain predominantly non-comparative. In pancreatic ductal adenocarcinoma, EUS-RFA remains investigational as an adjunct to systemic therapy. Conclusions: EUS-RFA is a promising therapeutic platform, but evidence remains highly indication-dependent and dominated by low-level observational studies. Standardized protocols, indication-specific outcomes, prospective registries, and comparative trials are needed.