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Open research questions in Prostate Cancer Diagnosis and Treatment

89 unresolved questions extracted from the limitations and future-work sections of 652 Prostate Cancer Diagnosis and Treatment papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Although the underlying mechanism the camera port in RALP is positioned at or just above the could not be determined from the present data, this pattern umbilicus, corresponding to the T9 dermatome, which lies could potentially involve inconsistent dermatomal coverage beyond the reliable coverage of the conventional lateral TAP requiring repeated rescue dosing, relatively shorter func- block (T10-L1) [4].

    Subcostal TAP block versus M-TAPA block as an adjunct to lateral TAP block in robot-assisted prostatectomy: a retrospective pilot matched cohort study · 2026 · DOI

  • Future developments in AI-assisted prostate cancer diagnostics are likely to focus on improving clinical applicability, generalizabil- ity, and seamless integration into diagnostic and therapeutic workflows (63). Large multicenter collaborations and federated learning frameworks may facilitate the development of more robust and representative models while preserving patient privacy and data security (64). At the same time, advances in explainable AI are expected to improve model transparency by enabling clinicians to better understand the histological features driving algorithm predictions, thereby increasing trust, supporting regulatory accep- tance, and facilitating clinical implementation (65, 66). Beyond conventional histopathology, AI is increasingly being integrated with molecular, genomic, and spatially resolved technol- ogies. Combining histomorphological assessment with spatial transcriptomics, proteomics, and other omics platforms may pro- vide deeper insights into tumor heterogeneity, biological behavior, therapeutic response, and mechanisms of disease progression, thereby supporting more precise risk stratification and personalized treatment selection (67–70). Similarly, AI-assisted analysis of im- munohistochemical biomarkers may enable more objective and reproducible quantification of biomarker expression, improving diagnostic accuracy, prognostic assessment, and patient selection for targeted therapeutic strategies in selected clinical settings (71). Future advances are also likely to support the development of integrated multimodal models that combine histopathological, molecular, radiological, and clinical data to generate comprehensive patient-specific risk profiles. Such approaches may further refine prognostic prediction and facilitate precision oncology by identify- ing patients most likely to benefit from active surveillance, treat- ment intensification, or targeted therapies. Ultimately, the future of AI in prostate cancer diagnosis is likely to depend on effective human–AI collaboration rather than full automa- tion. In this paradigm, AI serves as a decision-support tool that enhances diagnostic consistency, efficiency, quantitative assessment, and risk stratification, while final clinical and pathological decisions remain under expert supervision (72). Such collaborative approaches are likely to maximize the benefits of AI while preserving the clinical judgment essential for individualized patient care.

    Artificial intelligence in prostate biopsy: diagnostic applications, risk stratification, and precision oncology · 2026 · DOI

  • Importance: Magnetic resonance imaging (MRI) is increasingly used for local staging in prostate cancer, yet its value relative to digital rectal examination (DRE) staging remains uncertain.

    Performance of MRI-Based vs Clinical T Staging in Localized Prostate Cancer · 2026 · DOI

  • Background/Objectives: Secondary pelvic cancer (SC) risk after radiotherapy (RT) for prostate cancer (PC) remains uncertain; we performed an updated synthesis of observational studies and randomized trials.

    Risk of Secondary Pelvic Cancers Following Radiotherapy for Prostate Cancer · 2026 · DOI

  • KPS predicted physical, role, and social functioning but not emotional or cognitive outcomes (sexual outcomes were not analyzed in regression due to insufficient data), underscoring its role as a physical performance measure rather than a global QoL indicator.

    Symptom cluster profiles and their impact on quality of life in Chinese patients with prostate cancer undergoing ADT: a cross-sectional study · 2026 · DOI

  • KPS score predicted physical, role, and social functioning but not emotional or cognitive outcomes (sexual outcomes were not analyzed in regression due to insufficient data).

    Symptom cluster profiles and their impact on quality of life in Chinese patients with prostate cancer undergoing ADT: a cross-sectional study · 2026 · DOI

  • The optimal biopsy approach—systematic biopsy (SB), MRI-ultrasound fusion targeted biopsy (TB), or their combination (CB)—remains debated, especially in patients with high-risk Prostate Imaging-Reporting and Data System (PI-RADS) 4-5 lesions.

    Diagnostic Comparison of MRI/Ultrasound Fusion Biopsy and Systematic Biopsy in PI-RADS 4-5 Prostate Lesions · 2026 · DOI

  • We reported pre- viously a modest additional diagnostic yield of PSMA-PET/ CT in patients with mpMRI-negative or equivocal findings corresponding to PI-RADS categories 1–3, with csPCa detected in 22% of men [16].

    External validation of the P-Score in the prospective, pre-biopsy DEPROMP cohort: integrated mpMRI and PSMA PET/CT risk stratification for prostate cancer detection · 2026 · DOI

  • Although various AI models have demonstrated clinical value, most have not been put into practical clinical use, which highlights the significant limitations of current AI technology.

    AI-driven precision diagnosis and treatment of prostate cancer: a narrative review · 2026 · DOI

  • 30% drug dose) are clinically appropriate and consistency guideline-concordant. Follow-up rationality 20% Follow-up intervals and required investigations are guideline-concordant and individualized.

    Comparison of DeepSeek-V3.2 and ChatGPT-5.2 in the outpatient diagnosis and treatment of prostate cancer: a multicenter evaluation of application value and multilingual adaptability · 2026 · DOI

  • 30% drug dose) are clinically appropriate and consistency guideline-concordant. Follow-up rationality 20% Follow-up intervals and required investigations are guideline-concordant and individualized.

    Comparison of DeepSeek-V3.2 and ChatGPT-5.2 in the outpatient diagnosis and treatment of prostate cancer: a multicenter evaluation of application value and multilingual adaptability · 2026 · DOI

  • Robot-assisted or minimally invasive simple prostatectomy (RASP/MISP) and anatomic endoscopic enucleation of the prostate (AEEP) have both emerged as minimally invasive alternatives to open simple prostatectomy, but their comparative perioperative performance in very large glands remains incompletely defined.

    Robot-Assisted Simple Prostatectomy Versus Endoscopic Enucleation for Large-Volume Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis of Perioperative Outcomes and Complications · 2026 · DOI

  • Because long-term oncologic data remain limited, stan- dardized imaging criteria and careful integration of MRI, PSA kinetics, and biopsy results will be critical for assess- ing treatment success and guiding patient management.

    Transurethral ultrasound ablation for prostate cancer: MRI-based pre-treatment planning and post-treatment assessment—what the radiologist needs to know · 2026 · DOI

  • Digital rectal examination is a clinical skill with a long history. Although it is not outdated, its popularity has been challenged by more recent technology, especially in the areas of trauma and cancer detection. It still provides a quick, inexpensive, multifaceted examination option, especially in circumstances when more advanced diagnostic facilities are either unavailable or too expensive. To ensure that this vital, low- tech diagnostic tool is used correctly to optimize patient benefit, future initiatives must concentrate on standardizing methodology and enhancing clinician education.

    Digital Rectal Examination: Current Perspectives and Applications of a Timeless Clinical Art · 2026 · DOI

  • The prospective design of this study allowed systematic evaluation of clinical presentation, treatment timelines, and early outcomes. It also provides valuable data from a region with limited published evidence. However, limitations include the relatively small sample size and focus on short-term outcomes. Long-term survival and disease progression were not assessed. Larger multicentre studies are needed to validate these findings and further evaluate the safety and effectiveness of pADT.

    Presumptive androgen deprivation therapy in prostate cancer emergencies: an ambispective study of clinical presentation, diagnostic delays and early outcomes in Nigerian hospitals · 2026 · DOI

  • imaging As technology and procedural expertise continue to advance, further research on MRI-guided transgluteal techniques is warranted to better define their role in improving accuracy, safety and patient-centred care in prostate cancer diagnostics and interventions.

    The First Magnetic Resonance Imaging–Guided Transgluteal Prostate Biopsy in Hong Kong: Technique and Initial Experience · 2026 · DOI

  • Due to the lim- ited sample size and incomplete post-discharge follow-up data for some patients undergoing PCa management or requiring endocrine therapy, there were insufficient RP specimens for comprehensive analysis.

    A retrospective study comparing multimodal fusion biopsy and conventional cognitive fusion biopsy for diagnosing prostate cancer · 2026 · DOI

  • We conclude that urinary CR is a candidate non-invasive biomarker complementary to PSA -- improving gray-zone triage and predicting PCSM; prospective validation in biopsy-referred cohorts is warranted.

    Urinary Creatine Riboside Complements PSA to Improve Disease Detection in the Diagnostic Gray Zone of Prostate Cancer · 2026 · DOI

  • Background/Objectives: Although the presence and diameter of the cribriform pattern (CP) are established prognostic factors in prostate cancer (PCa), the clinical impact of quantitative cribriform tumor burden (CTB) remains poorly characterized.

    Cribriform Tumor Burden in Grade Group 4 Prostate Cancer: A Quantitative Threshold Predicting Lymphovascular Invasion and Metastasis · 2026 · DOI

  • The early and accurate detection of PCa is central to improving patient outcomes and reducing unnecessary treatment-related morbidity. Serum Prostate-Specific Antigen (PSA) has been the primary screening biomarker for several decades; however, including poor it suffers from well-recognized specificity, as PSA elevations may arise from benign prostatic hyperplasia (BPH), prostatitis, or other non-malignant conditions. Reliance on PSA alone to trigger biopsy has historically resulted in 40–65% of performed biopsies being redundant, exposing patients unnecessarily to the risks of bleeding, infection, pain, and psychological distress, while simultaneously leaving up to 30% of clinically significant PCa undetected due to the inherent sampling limitations of Transrectal Ultrasound (TRUS)-guided systematic biopsy. These shortcomings have catalyzed the search for non-invasive functional imaging techniques capable of more precisely characterizing prostatic lesions before a histopathological decision is made. J Med Res Surg, ISSN: 2582-9572 Page 57 of 62 Volume 7 • Issue 3 • 208 Citation: Panhwer U, Shaikh A, Khattri Y, et al. Diagnostic Accuracy of Diffusion-Weighted Imaging and PSA for Prostate Carcinoma Using Histopathology as the Gold Standard: A Cross-Sectional Study. J Med Res Surg. 2026;7(3):57-62.

    Diagnostic Accuracy of Diffusion-Weighted Imaging and PSA for Prostate Carcinoma Using Histopathology as the Gold Standard: A Cross-Sectional Study · 2026 · DOI

  • The study has some important limitations. The most sig- nificant is the age imbalance between diabetic and control groups, which introduces residual confounding despite statistical adjustment. Because PSA and cardio-metabolic markers are strongly age-dependent, the lack of age match- ing limits the strength of causal inference and reduces con- fidence in unadjusted between-group comparisons. The use of consecutive sampling in a clinical setting also reduced control over group comparability. The control group was smaller than initially planned, reflecting recruitment constraints during the study period. This may have reduced statistical power and contributed further to group imbalance. In addition, several pre-analyti- cal factors that may influence PSA, including recent ejacu- lation, prostate manipulation, and physical exertion, were not standardised before sample collection. Undiagnosed benign prostatic conditions also could not be fully excluded. Finally, the case-control design and single time-point mea- surements prevent conclusions about temporal or causal relationships between metabolic factors and PSA.

    Prostate-Specific Antigen and Cardio-Metabolic Biomarkers in Nigerian Men With and Without Type 2 Diabetes: A Case-Control Study · 2026 · DOI

  • Several limitations should be considered when interpreting our results. For one, patients residing in rural areas comprised an overall small percentage of the total study population and generalizability concerns must be acknowledged. In addition, our use of International Classification of Diseases, tenth edition codes to identify patients with elevated PSA precluded our ability to assess the relationship between receipt of MRI and absolute PSA value.

    Utilization of Prediagnostic Prostate Magnetic Resonance Imaging Among Rural Americans: An Analysis of Medicare Claims for Elevated Prostate-Specific Antigen · 2026 · DOI

  • This study has several limitations. First, this study is a single- center retrospective study with a relatively limited sample size (n = 89). The study population mainly consisted of patients with suspected prostate cancer who underwent biopsy, leading to a high proportion of PCa and a certain degree of selection bias, which may aect the generalizability of the conclusions. Second, the PRE index and the combined judgment criterion for the PRIMARY score 4 “gray zone” (SUVmax ≥ 7.5) proposed in this study are exploratory results constructed based on data from our center; their universality and robustness still require external validation with multi-center, large-sample data. Third, not all patients underwent radical prostatectomy, and needle biopsy involves sampling error, which may not fully reflect the true biological characteristics of the tumor. Fourth, some patients with benign findings had a relatively short follow-up period, posing a potential risk of misclassification. Finally, our study relied exclusively on PSMA PET/CT; in the future, multi-parameter models could be constructed by combining PI-RADS scores, PSA density (PSAD), and other indicators to further enhance the eÿcacy of identifying csPCa.

    Diagnostic value of PRIMARY score and a combined model with SUVmax in 18F-PSMA-1007 PET/CT for prostate cancer · 2026 · DOI

  • The 12-year study period (2011–2022) poses a potential temporal bias. However, the use of standardised PI-RADS reporting by expert uroradiologists and the high surgical volume of the participating centres ensured consistent diagnostic and technical quality throughout the cohort. Furthermore, potential centre-related bias was minimized by standardised protocols. A sensitivity analysis incorporating the surgical institution into the multivariable model confirmed that the hospital centre was not a significant predictor of oncological outcomes (p = 0.784). Additionally, some regression estimates—particularly for conversion to open/laparoscopic surgery—showed extreme values due to sparse data and possible quasi-complete separation. Although sensitivity analyses using penalized regression confirmed the direction of these results should be interpreted cautiously.

    Association of preoperative multiparametric MRI with oncological and functional outcomes following robot-assisted radical prostatectomy: a multicentre prospective study · 2026 · DOI

  • Multimodal AI for diagnosis of clinically significant prostate cancer has been evaluated in multicenter studies (reference 57), but longitudinal validation of AI-derived predictions against long-term biochemical recurrence, metastasis-free survival, and castration resistance endpoints in independent prospective cohorts is absent.

    Multimodal artificial intelligence in urologic precision oncology: from algorithm to translational medicine (a systemized narrative review) · 2026 · DOI

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89 open questions have been extracted from the limitations and future-work passages of 652 Prostate Cancer Diagnosis and Treatment papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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