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Next-generation imaging (NGI), particularly with prostate-specific membrane antigen positron emission tomography (PSMA PET) tracers, enables earlier and more accurate detection of metastases. However, conventional imaging (CT and bone scan) remains more affordable and widely accessible and was the standard used in most pivotal trials that established current survival outcomes. As PSMA PET becomes more widely adopted, a stage migration effect is emerging. However, key uncertainties persist regarding the actual proportional employment of NGI in clinical practice, main indications for its use and the mid-term and long-term effects of an NGI-driven treatment pathway. Furthermore, when or whether CI alone might remain enough informative for the treatment decision-making is still unclear.
The European Registry of Next-Generation Imaging in Advanced Prostate Cancer is a non-profit, non-interventional, multi-centre, international, prospective, investigator-initiated registry that is intended to collect real-world data on how patients with prostate cancer at risk of harbouring metastasis (high-risk at initial diagnosis, or after primary treatment) are managed according to the type of imaging used for the systemic work-up. The registry is conducted in two phases: (1) cross-sectional analysis of imaging choices and their effect on clinical decision-making and (2) longitudinal follow-up evaluating survival outcomes such as progression-free survival (PFS), disease-specific survival (DSS) and skeletal-related events (SSEs). Statistical analyses will include descriptive analysis of demographic and clinical variables, comparative analysis between different imaging pathways, survival and prognostic analyses using Kaplan–Meier tests. The expected minimum sample size of the registry is 600 patients, and the planned follow-up duration is 24 months for the longitudinal follow-up.
The study protocol was approved by the ethics committee of Fundació Puigvert (#C2024/30), and ethics approval is required at all participating sites. All patients will provide written informed consent. The results will be disseminated widely and transparently to maximise their effect on clinical practice, research and patient care through peer-reviewed publications, presentations at international conferences as well as through patient advocacy groups and relevant patient websites.
by Linda C. Theron, Adrian D. van Breda
Introduction and objectiveA multisystemic approach to researching resilience investigates resources across multiple systems, including biological, psychological, social, institutional, structural, environmental, and cultural systems, with special interest in how these resources co-act to enable better-than-expected outcomes among risk-exposed children and youth. This approach is an important step toward redressing neoliberal misinterpretations of resilience as a personal capacity. However, it is unclear how well a multisystemic approach is reflected in recent studies of child and youth resilience conducted in South Africa, a country where ongoing structural violence demands resilience from most children and youth. In response, this article reports a scoping review of South African child and youth resilience studies published between 2018 and 2023.
MethodologyThe methodology aligned with the PRISMA extension for Scoping Reviews. The authors systematically scoped the available literature (n = 1309 records) to determine which resources from which systems were associated with the resilience of South African children and youth (birth to 29 years). Using a multisystem resilience framework, the narrative review of 99 eligible studies documents the biological, psychological, social, institutional, structural, environmental and cultural resources that enabled better-than-expected outcomes among risk-exposed children and youth.
ResultsPsychological and social resources were more prominently reported than biological, institutional, structural, environmental or cultural resources. Two-thirds of the included studies reported resources from two or more systems, with psychological and social systems dominating multisystem studies. Despite the inclusion of multiple systems, studies seldom reported co-acting resources.
DiscussionAlthough the attention to resources across multiple systems is encouraging, child and youth resilience agendas will be better served by studies that document co-acting resources. This will allow policymakers and service providers to gauge the additive effects of multiple resources and which combinations of resources are most likely to advance young people’s resilience.
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