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BackgroundInnovations in imaging and molecular characterisation together with novel treatment options have improved outcomes in advanced prostate cancer. However, we still lack high-level evidence in many areas relevant to making management decisions in daily clinical practise. The 2022 Advanced Prostate Cancer Consensus Conference (APCCC 2022) addressed some questions in these areas to supplement guidelines that mostly are based on level 1 evidence.ObjectiveTo present the voting results of the APCCC 2022.Design, setting, and participantsThe experts voted on controversial questions where high-level evidence is mostly lacking: locally advanced prostate cancer; biochemical recurrence after local treatment; metastatic hormone-sensitive, non-metastatic, and metastatic castration-resistant prostate cancer; oligometastatic prostate cancer; and managing side effects of hormonal therapy. A panel of 105 international prostate cancer experts voted on the consensus questions.Outcome measurements and statistical analysisThe panel voted on 198 pre-defined questions, which were developed by 117 voting and non-voting panel members prior to the conference following a modified Delphi process. A total of 116 questions on metastatic and/or castration-resistant prostate cancer are discussed in this manuscript. In 2022, the voting was done by a web-based survey because of COVID-19 restrictions.Results and limitationsThe voting reflects the expert opinion of these panellists and did not incorporate a standard literature review or formal meta-analysis. The answer options for the consensus questions received varying degrees of support from panellists, as reflected in this article and the detailed voting results are reported in the supplementary material. We report here on topics in metastatic, hormone-sensitive prostate cancer (mHSPC), non-metastatic, castration-resistant prostate cancer (nmCRPC), metastatic castration-resistant prostate cancer (mCRPC), and oligometastatic and oligoprogressive prostate cancer.ConclusionsThese voting results in four specific areas from a panel of experts in advanced prostate cancer can help clinicians and patients navigate controversial areas of management for which high-level evidence is scant or conflicting and can help research funders and policy makers identify information gaps and consider what areas to explore further. However, diagnostic and treatment decisions always have to be individualised based on patient characteristics, including the extent and location of disease, prior treatment(s), co-morbidities, patient preferences, and treatment recommendations and should also incorporate current and emerging clinical evidence and logistic and economic factors. Enrolment in clinical trials is strongly encouraged. Importantly, APCCC 2022 once again identified important gaps where there is non-consensus and that merit evaluation in specifically designed trials.

Deregulation of cell cycle that results in uncontrolled cellular proliferation is the basis of neoplastic process. Bladder tumors are heterogenous in their behavior, and it is very difficult to predict the clinical course in many patients. In order to alleviate this problem, attention has been focused on mutations in various cell cycle regulators and their association with tumor behavior. Mutations of the p16/CDKN2 gene, encoding a cyclin-dependent kinase inhibitor, are common in bladder cancer. In contrast to other tumor suppressor genes, the two most common mechanisms for loss of p16/CDKN2 function are homozygous deletion and loss of transcription associated with hyperméthylation of the 5'CpG island region. Recently, it is found that méthylation of p16/CDKN2 is potentially reversible with exposure to demethylating agents, such as 5- aza-2'-deoxycytidine, which is a well-established inhibitor of DNA méthylation, which may open up new ways to effective tumor management.Key Words: Méthylation, Bladder cancer, Cell cycle

Objective: In this retrospective study, we evaluated the ability of preoperative parameters to predict tumor significance in men with stage T1c disease who underwent radical retropubic prostatectomy.Patients and Methods: A total of 26 consecutive patients who underwent radical retropubic prostatectomy owing to clinically localized disease fulfilled the criteria for insignificant cancer namely PSA density lower or equal to 0.10, presence of Gleason grade

Objective: p53 and androgen receptor gene changes and bcl-2 expression in prostatic intraepithelial neoplasia (PIN) and adenocarcinoma were studied. The genetic associations of PIN and adenocarcinoma as detected by FISH and immunohistochemistry were discussed.Material and Method: The study group consisted of 18 prostate cancer cases treated by radical prostatectomy. The p53 and androgen receptor gene changes at chromosomal level were studied using the FISH technique. Also, immunohistochemistry was used to search for bcl-2 expression.Results: Of the 18 cases studied by FISH, it was found that in benign areas AR gene amplification was 78% (14/18) and 100% disomy with wild type p53, in PIN areas AR gene amplification was 33% (6/18), p53 amplification 28% (5/18), in carcinomas AR gene amplification was 39% (7/18), and p53 amplification 28% (5/18). We observed the bcl-2 immunexpression mainly in basal ductal cells in benign, PIN and carcinoma areas.Conclusion: The results of our study suggest that AR gene amplification is significantly higher in benign areas compared to carcinomatous foci and that the presence of AR gene amplification is associated with the tumour stage. PIN is the most likely precursor of prostatic carcinoma.Key Words: Androgen receptor gene, p53, FISH, Prostate carcinoma

Objective: The etiology of microscopic andmacroscopic hematuria may range fromconditions posing minimal risk to the patient topotentially life-threatening conditions. There arecontraversial ideas about the evaluation ofhematuria. In this survey, we examined thenecessity of cystoscopy in patients withmicroscopic and macroscopic hematuria whowere radiologically and microbiologically normal.Methods: A total of 139 patients withmicroscopic or macroscopic hematuria who weremicrobiologically and radiologically normal andhad cystoscopy between 1991 and 2003 wereretrospectively analyzed. Routine history,physical examination, routine blood tests, urineanalysis, urine culture, a plain radiography,urinary system ultrasonography / intravenouspyelography, computerized tomography andtuberculosis tests, including ARB-Bactec wereunable to diagnose a pathology to identify thereason for hematuria, and cystoscopy wasperformed on all patients.R e su lts : Seventy five (53.9%) patients weremale and 64 (46.1%) were female. There wasno pathology in 86 (61.8%) patients indiagnostic cystoscopy whereas, 21(15.2%) hada papillary tumor and 16 (11.5%) had asuspicious lesion in the bladder that wasbiopsied. In 16 (11.5%) patients prostatichypertrophy was the only cystoscopic finding.According to the histopathological examination,15 (93.5%) of the suspicious lesion biopsieswere benign, but 1 (6.5%) patient hadcarcinoma in-situ. All of the papillary lesionswere reported as superficial transitional cellcarcinoma (TCCA). Overall, TCCA was detectedin 4(4.9%) and 18(31%) patients withmicroscopic and macroscopic hematuria,respectively. Irrespective of the type of thehematuria, none of the patients under 40 yearsof age were found to have bladder cancer.C o n c lu s io n : Our findings indicate that allpatients older than 40 years of age withmicroscopic and macroscopic hematuria shouldundergo a cystoscopy. The current study furthersuggests that patients younger than 40 years ofage with microscopic hematuria can only besafely followed up with non-invasive methods,without performing cystoscopy.K e y W o rd s : Microscopic, Macroscopic,Hematuria, Cystoscopy, Diagnosis

Patients with advanced prostate cancer (APC) may be at greater risk for severe illness, hospitalisation, or death from coronavirus disease 2019 (COVID-19) due to male gender, older age, potential immunosuppressive treatments, or comorbidities. Thus, the optimal management of APC patients during the COVID-19 pandemic is complex. In October 2021, during the Advanced Prostate Cancer Consensus Conference (APCCC) 2021, the 73 voting members of the panel members discussed and voted on 13 questions on this topic that could help clinicians make treatment choices during the pandemic. There was a consensus for full COVID-19 vaccination and booster injection in APC patients. Furthermore, the voting results indicate that the expert’s treatment recommendations are influenced by the vaccination status: the COVID-19 pandemic altered management of APC patients for 70% of the panellists before the vaccination was available but only for 25% of panellists for fully vaccinated patients. Most experts (71%) were less likely to use docetaxel and abiraterone in unvaccinated patients with metastatic hormone-sensitive prostate cancer. For fully vaccinated patients with high-risk localised prostate cancer, there was a consensus (77%) to follow the usual treatment schedule, whereas in unvaccinated patients, 55% of the panel members voted for deferring radiation therapy. Finally, there was a strong consensus for the use of telemedicine for monitoring APC patients. Patient summary In the Advanced Prostate Cancer Consensus Conference 2021, the panellists reached a consensus regarding the recommendation of the COVID-19 vaccine in prostate cancer patients and use of telemedicine for monitoring these patients.