Prostate Cancer and Prostatic Diseases最新文献

{"title":"EMETPRO: a multicentric, international, retrospective analysis evaluating patients with metastatic hormone-sensitive prostate cancer with early progression","authors":"Fabio Turco, Silke Gillessen, Giuseppe Salfi, Iris S. H. Kloots, Peter H. J. Slootbeek, Niven Mehra, Matthew Labriola, Daniel J. George, Amanda Broderick, Anna Patrikidou, Hortense Patry, Consuelo Buttigliero, Veronica Crespi, Hirotsugu Uemura, Kazutoshi Fujita, Takanobu Utsumi, Hiroyoshi Suzuki, Daniele Raggi, Umberto Basso, Rafael Morales-Barrera, David Marmolejo Castaneda, Cora N. Sternberg, Daniela Guevara, Orazio Caffo, Giuseppe Procopio, Andrea Zivi, Sara Merler, Mariella Sorarù, Daniel E. Spratt, Pedro C. Barata, Carlo Messina, Yüksel ürün, Hatice Bolek, Ignacio Duràn, Juan Diego Cacho Lavin, Nieves Martínez Chanzá, Lisa G. Horvath, Rhiannon Mellor, Levent Türkeri, Merve Bengisu Soykök, Sabrina Rossetti, Richard Cathomas, Giuseppe Luigi Banna, Vincenza Conteduca, Margaret Ottaviano, Laura Marandino, Hui-Ming Lin, Luigi Tortola, Ricardo Pereira Mestre, Martino Pedrani","doi":"10.1038/s41391-026-01124-5","DOIUrl":"10.1038/s41391-026-01124-5","url":null,"abstract":"Androgen deprivation therapy (ADT) + androgen receptor pathway inhibitor (ARPI)  ± docetaxel represent the standard of care in patients with metastatic hormone-sensitive prostate cancer (mHSPC). However, some patients still have early progression (EP). EMETPRO is a multicentric, retrospective registry of patients with EP mHSPC. Patients with EP mHSPC were defined as patients who had progression ≤6 months under ADT+docetaxel or ADT + ARPI or ≤9 months from ADT monotherapy start. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS). Data from eligible patients treated between 2005 and 2023 were retrospectively collected. 201 (50%) patients received ADT monotherapy, while 124 (31%) and 76 (19%) received ADT+docetaxel and ADT + ARPI, respectively. 365 (91%) patients underwent first-line treatment for mCRPC—majority of the ADT monotherapy received ARPI (38%) or docetaxel (34%), whereas 69% of the ADT+docetaxel received ARPI and 62% of the ADT + ARPI received docetaxel. In the group of patients treated with ADT the median PFS was 6.8 months while the median OS was 26.4. In the group of patients treated with combination therapy the median PFS and OS was 4.9 and 18.6 months for patients who received docetaxel and 5.6 and 19.5 months for patients who received ARPI, respectively. Neither the first-line mCRPC treatment nor the genetic profiles were associated with survival outcomes. The results of our study suggest that patients with EP mHSPC are characterized by poor outcomes regardless of the type of treatment received at progression. The optimal first-line mCRPC therapy to use in these patients remains a crucial unmet clinical need.","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 4","pages":"862-874"},"PeriodicalIF":6.9,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148056494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and safety of single-port transvesical simple prostatectomy in patients with very large prostates: A volume-stratified analysis","authors":"Jin-Chun Qi, Sheng Tang, Dong-Bin Wang, Ze-Lin Fu, Lorenzo Santodirocco, Marwan Alkassis, Ruben Sauer Calvo, Chang-Bao Qu, Ya-Xuan Wang, Simone Crivellaro","doi":"10.1038/s41391-026-01121-8","DOIUrl":"10.1038/s41391-026-01121-8","url":null,"abstract":"Single-port transvesical robot-assisted simple prostatectomy (SP-SP) is a minimally invasive treatment option for patients with large prostates. However, the impact of prostate volume on perioperative outcomes, particularly in patients with extremely large glands, has not been systematically evaluated. This study aimed to assess the safety and efficacy of SP-SP across different prostate volume strata. We retrospectively reviewed 90 consecutive patients who underwent SP-SP between 2020 and 2025 by a single surgeon. Patients were stratified by preoperative total prostate volume (TPV) into Group A (80–120 mL, n = 43), Group B (120–160 mL, n = 22), and Group C (>160 mL, n = 25). Perioperative parameters were compared among the three groups. Multivariate logistic regression analysis was performed to identify risk factors for postoperative complications. Baseline characteristics were generally comparable among groups. Pairwise comparisons showed that patients in Group C had significantly higher preoperative PSA levels than those in Group A, as well as longer operative time and greater estimated blood loss (EBL) compared with both Groups A and B. Aside from postoperative hemoglobin levels, recovery and safety outcomes were largely similar across groups. Multivariate analysis identified EBL as the only independent risk factor for postoperative complications, while TPV was not independently associated with complications. Specimen weight increased with increasing prostate volume, while the resection ratio was similar across groups. At the last follow-up, significant improvements were observed in PSA, PVR, IPSS, and QoL scores, as well as in the urinary continence across the three groups, with no significant differences between groups. These findings provide preliminary evidence supporting the feasibility of SP-SP in patients with very large prostates. Larger multicenter studies with adequate sample sizes and longer follow-up are warranted to further evaluate these results.","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 4","pages":"854-861"},"PeriodicalIF":6.9,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41391-026-01121-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148056426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of genitourinary toxicity following bladder outlet obstruction procedures in patients before versus after radiotherapy for localized prostate cancer: a retrospective cohort study using the TriNetX database.","authors":"Renil S Titus, Johnny Su, Carlos Riveros, Annie Chen, Hemendra N Shah, Raj Satkunasivam, Olamide Omidele, Ricardo R Gonzalez","doi":"10.1038/s41391-026-01117-4","DOIUrl":"https://doi.org/10.1038/s41391-026-01117-4","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have reported genitourinary toxicity associated with transurethral resection of the prostate after radiation therapy (XRT) for localized prostate cancer (PCa). However, treatment options for benign prostatic hyperplasia have expanded exponentially within the last decade. Using a more contemporary cohort and analyzing newer bladder outlet obstruction procedures (BOOP), this study aims to compare the rates of genitourinary toxicity in men who have undergone BOOP after versus before XRT for PCa.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX network. We identified 447 patients receiving BOOP after XRT (Cohort A) and 1 504 patients receiving BOOP before XRT (Cohort B). Cohorts were propensity-score matched for demographic, comorbidities and relevant medications. We stratified the analysis by type of procedure-minimally invasive surgical techniques (MISTs) or resective surgery (RS). Statistical analysis reporting risk ratios (RR) and 95% confidence intervals (95% CI) was conducted.</p><p><strong>Results: </strong>Each cohort consisted of 411 matched patients who were well balanced after PSM (SMD < 0.1). Patients in Cohort A had an increased risk of stress urinary incontinence [RR 4.29, 95% CI (2.19, 8.41)], urge urinary incontinence[RR 2.09, 95% CI (1.25, 3.49)], mixed urinary incontinence[RR 2.49, (1.21, 5.11)], urinary retention [RR 2.38, 95% CI (1.54, 3.68)], bladder neck contracture [RR 2.56, 95% CI(1.39, 4.68)] and urethral strictures [RR 3.28, 95% CI (1.83-5.88)] compared to patients in Cohort B. Outcomes for MISTs after versus before XRT were limited by small sample size but suggested no difference in the risk of genitourinary toxicity. Compared to RS before XRT, RS after XRT was associated with an increased risk of stress incontinence, urinary retention, bladder neck contracture, and urethral strictures.</p><p><strong>Conclusion: </strong>Men with a history of BOOP undergoing XRT have less genitourinary toxicity than those undergoing XRT after. To limit such toxicity, urologists should evaluate concomitant benign prostatic hyperplasia and consider BOOP before patients undergo XRT.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antifibrotic therapy for Lower Urinary Tract Symptoms secondary to Benign Prostatic Hyperplasia.","authors":"Ajinkya R Limkar, Kevin T McVary, William A Ricke, Matthew S Lee","doi":"10.1038/s41391-026-01119-2","DOIUrl":"10.1038/s41391-026-01119-2","url":null,"abstract":"<p><strong>Background: </strong>Lower Urinary Tract Symptoms secondary to Benign Prostatic Hyperplasia (LUTS/BPH) are a ubiquitous condition estimated to affect over 50% of men over the age of 50 years. Various treatment options exist for men presenting with LUTS/BPH, including lifestyle and behavioral modification and medical or surgical treatment. Although multiple medical treatments exist, innovation for the medical treatment of BPH has not significantly progressed.</p><p><strong>Methods: </strong>A comprehensive narrative review was performed to evaluate prostate fibrosis as a contributor to LUTS/BPH and to identify potential antifibrotic therapies that may be applicable to the treatment of LUTS/BPH. A literature search was conducted in PubMed and ClinicalTrials.gov for molecular, translational, and clinical studies relevant to fibrosis in benign prostatic diseases. Keyword searches included \"benign prostatic hyperplasia\", \"lower urinary tract symptoms\", \"prostate fibrosis\", \"fibrosis\", \"antifibrotics\", as well as combinations of these terms.</p><p><strong>Results: </strong>In this narrative review, we review the rationale and evidence for pursuing antifibrotic therapy as a novel treatment strategy for LUTS/BPH. We discuss potential antifibrotics that could be used for the treatment of LUTS/BPH. Finally, we discuss diagnostic studies that could be used in the future to identify patients with LUTS secondary to prostate fibrosis.</p><p><strong>Conclusions: </strong>Emerging evidence suggests that prostate fibrosis contributes to the development of LUTS. No antifibrotic therapies are currently being used, leaving LUTS secondary to fibrosis untreated. Antifibrotics are a novel medication class that could be used to treat patients who progress on current BPH medications.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13482506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond satisfaction scores: quantifying communication quality in oncology care","authors":"Mark Taratkin,&nbsp;Stessy Kutchukian,&nbsp;Enrico Checcucci,&nbsp;On behalf of YAU of EAU Working Group Urotechnology & Digital Health","doi":"10.1038/s41391-026-01123-6","DOIUrl":"10.1038/s41391-026-01123-6","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 4","pages":"667-668"},"PeriodicalIF":6.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41391-026-01123-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salvage radiotherapy with or without hormonal therapy for biochemical recurrence after radical prostatectomy: A systematic review and meta-analysis.","authors":"Fortuna Migliaccio, Fabiano Flauto, Chiara Barraco, Giuseppe Neola, Sarah Scagliarini, Ciro Franzese, Emanuele Chioccola, Gaetano Facchini, Roberto Bianco, Alberto Servetto, Luigi Formisano","doi":"10.1038/s41391-026-01120-9","DOIUrl":"https://doi.org/10.1038/s41391-026-01120-9","url":null,"abstract":"<p><strong>Background: </strong>Salvage radiotherapy (SRT) is the standard of care for patients with biochemical recurrence (BCR) after radical prostatectomy (RP). Several randomized trials have evaluated the addition of hormonal therapy (HT), including androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs), to SRT; however, differences in patient selection, treatment duration, and endpoints have led to inconsistent results. We performed an updated systematic review and meta-analysis to clarify the clinical benefit of adding HT to SRT in this setting.</p><p><strong>Methods: </strong>A comprehensive literature search of PubMed/MEDLINE, EMBASE, the Cochrane Library, ClinicalTrials.gov, and ASCO and ESMO meeting abstracts was conducted through April 2025. Randomized phase II-III trials enrolling patients with confirmed BCR after RP and comparing SRT with or without HT were included. Five trials (GETUG-AFU 16, RTOG 9601, RTOG 0534/SPPORT, RADICALS-HD, and SALV-ENZA), comprising 4536 patients, met the eligibility criteria. Hazard ratios (HRs) and 95% confidence intervals (CIs) for metastasis-free survival (MFS), progression-free survival (PFS), biochemical progression-free survival (bPFS), and overall survival (OS) were pooled using fixed- or random-effects models according to heterogeneity. Analyses were stratified by HT duration (short-term vs. long-term), and subgroup analyses were performed based on pathological features.</p><p><strong>Results: </strong>Short-term HT combined with SRT significantly improved bPFS (HR = 0.57; 95% CI: 0.46-0.71, p < 0.00001), PFS (HR = 0.58; 95% CI: 0.49-0.69; p < 0.00001), and MFS (HR = 0.82; 95% CI: 0.69-0.96; p = 0.02). Long-term HT was also associated with improved MFS (HR = 0.76; 95% CI: 0.61-0.94; p = 0.01). No statistically significant OS benefit was observed with either short-term or long-term HT. Subgroup analyses showed a significant MFS benefit in patients with positive surgical margins (HR = 0.68; 95% CI: 0.47-0.98; p = 0.04), whereas no clear benefit was detected in patients with Gleason score ≥8 or negative margins.</p><p><strong>Conclusions: </strong>The addition of HT to SRT improves disease control outcomes in patients with BCR after RP, particularly in those with positive surgical margins, although no overall survival benefit was demonstrated. These findings support a tailored approach to treatment intensification in the salvage setting.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistence, progression, and PSA: what exactly does DEAR-EXT compare?","authors":"Yanping Zhu, Xiaohui Wang, Yang Zhang, Shuangwu Lv","doi":"10.1038/s41391-026-01122-7","DOIUrl":"10.1038/s41391-026-01122-7","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrast-free MRI-first screening in young asymptomatic men: Prostate characteristics and cancer detection rates","authors":"Emanuele Messina,&nbsp;Ludovica Laschena,&nbsp;Antonella Borrelli,&nbsp;Francesca Mezzapesa,&nbsp;Sara Lucciola,&nbsp;Luca Giuliani,&nbsp;Paolo Giuliani,&nbsp;Marco Bicchetti,&nbsp;Alessandro Sciarra,&nbsp;Valeria Panebianco","doi":"10.1038/s41391-026-01116-5","DOIUrl":"10.1038/s41391-026-01116-5","url":null,"abstract":"Early-onset prostate cancer is becoming increasingly prevalent, and MRI-first strategies are gaining interest as a potential screening tool. However, MRI characteristics of the prostate in younger men remain underexplored. This study aimed to characterize prostate MRI features in a young, asymptomatic male cohort undergoing contrast-free biparametric MRI for prostate cancer screening, to determine the detection rate of clinically significant prostate cancer, and to identify clinical and imaging predictors of clinically significant disease. A total of 659 prostate MRIs were acquired; after excluding men who declined biopsy, 641 participants formed the final cohort. Peripheral-zone signal patterns on T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps were assessed by two blinded radiologists. PI-RADS scores were assigned independently. Men with PI-RADS ≥ 4 were offered targeted MRI–TRUS fusion biopsy (PI-RADS 3 in case of PSAD ≥ 0.16). Multivariable logistic regression was performed to identify independent predictors of csPCa. Median PSA 1.02 ng/mL (IQR 0.58–2.03) and PSA density (PSAD) 0.03 ng/mL/mL (IQR 0.02–0.05). The most common peripheral-zone appearance was heterogeneous T2 hypointensity (74.7%), homogeneous DWI hyperintensity (59.4%), and homogeneous ADC hypointensity (66.1%). PI-RADS distribution was: 0.5% PI-RADS 1, 81.1% PI-RADS 2, 14.2% PI-RADS 3, 3.6% PI-RADS 4, and 0.6% PI-RADS 5. Forty-one men (6.4%) underwent biopsy, yielding 5 ciPCa, 23 csPCa, and 13 negative results, corresponding to csPCa in 3.6% of the entire cohort. In multivariable analysis, PSAD ≥ 0.15 ng/mL/mL, PI-RADS 4–5, and family history were independently associated with csPCa (all p &lt; 0.01). Contrast-free bpMRI effectively characterizes prostate morphology in younger men and identifies csPCa at an early stage. PSAD, PI-RADS category, and family history significantly enhance risk stratification, supporting the integration of bpMRI-based approaches into future MRI-first screening strategies for younger, asymptomatic populations.","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 4","pages":"846-853"},"PeriodicalIF":6.9,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41391-026-01116-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostate biopsy - current discussions and future perspectives","authors":"August Sigle,&nbsp;Giorgio Gandaglia,&nbsp;Veeru Kasivisvanathan,&nbsp;Christian Gratzke,&nbsp;Giancarlo Marra,&nbsp;and the YAU Prostate Cancer Group","doi":"10.1038/s41391-026-01109-4","DOIUrl":"10.1038/s41391-026-01109-4","url":null,"abstract":"","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":"29 4","pages":"772-774"},"PeriodicalIF":6.9,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the utility of artificial intelligence in identifying progression of prostate cancer during active surveillance: A systematic review.","authors":"Jianliang Liu, Dixon T S Woon, Wafy Ahmad, Thomas P Cundy, Thilakavathi Chengodu, Nanadakishor Desai, Marimuthu Palaniswami, Marlon Perera, Nathan Lawrentschuk","doi":"10.1038/s41391-026-01107-6","DOIUrl":"https://doi.org/10.1038/s41391-026-01107-6","url":null,"abstract":"<p><strong>Background: </strong>There is a recent surge in interest in the application of artificial intelligence (AI) in prostate cancer (PCa). When evaluating PSMA PET scans, AI has shown promise in detecting intraprostatic cancer and metastatic disease. This systematic review aims to assess the ability of AI to detect or predict the progression of PCa during AS.</p><p><strong>Methods: </strong>This systematic review was registered on PROSPERO (ID CRD42024529354) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A comprehensive literature search was performed on Medline, Embase, Web of Science, and IEEE Xplore. Only studies evaluating AI in AS-eligible patients were included.</p><p><strong>Results: </strong>After screening 842 articles, 12 studies were suitable for inclusion. The included studies comprised of 4622 AS patients of whom 1022 experienced progressions. Only three studies utilised developed their AI purely on clinicopathological variables. The area under curve (AUC) of these three AI ranged between 0.65 and 0.76, and the AI algorithm in one study outperformed traditional logistic regression. The integration of MRI parameters particularly the use of radiomics improves the ability of AI to predict progression as compared to clinicopathological variables alone. AI was also able to analyse serial MRI during AS and performs on par with the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system. The AUC of the AI algorithms which included MRI parameters ranged between 0.65 and 0.95. One of the limitations was the variability in study methodologies and inclusion criteria. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used and none of the studies had high risk of bias.</p><p><strong>Conclusion: </strong>AI shows promise in detecting PCa progression during AS. However, this systematic review highlights the need for larger prospective studies with external validation before AI can be integrated into the AS process.</p>","PeriodicalId":20727,"journal":{"name":"Prostate Cancer and Prostatic Diseases","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}