Clinical genitourinary cancer最新文献

{"title":"Impact of Muscle Depletion on Prognosis in Patients Undergoing Radical Cystectomy","authors":"Xiangyu Pang,&nbsp;Lei Jiang,&nbsp;Haiyun Wang,&nbsp;Lei Luo,&nbsp;Tongpeng Liu,&nbsp;Lijiang Sun,&nbsp;Guiming Zhang","doi":"10.1016/j.clgc.2025.102373","DOIUrl":"10.1016/j.clgc.2025.102373","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the prognostic impact of preoperative muscle depletion (including sarcopenia and myosteatosis) in patients with bladder cancer (BCa) after radical cystectomy (RC).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 185 patients undergoing RC for urothelial carcinoma. We used the computed tomography images at the L3 level of patients to get the skeletal muscle index (SMI) and skeletal muscle density (SMD). Sarcopenia is defined by the SMI while myosteatosis is defined by SMD. We used univariate Cox regression analysis to identify risk factors and included these risk factors in a multivariate Cox regression analysis to calculate the hazard ratio (<em>HR</em>) and 95% confidence interval (<em>95% CI</em>).</div></div><div><h3>Results</h3><div>In the univariate Cox analysis, sarcopenia (<em>P &lt; .</em>001) and myosteatosis (<em>P = .</em>017) were both associated with poorer overall survival (OS). Meanwhile, sarcopenia (<em>P &lt; .</em>001) and myosteatosis (<em>P = .</em>019) were both associated with poorer progression-free survival (PFS). In the multivariate Cox analysis, sarcopenia was identified as an independent risk factor for both OS (<em>P = .</em>018) and PFS (<em>P = .</em>005), whereas myosteatosis was not an independent risk factor for OS (<em>P = .</em>225) or PFS (<em>P = .</em>104).</div></div><div><h3>Conclusions</h3><div>Preoperative muscle depletion (including sarcopenia and myosteatosis) significantly correlates with poor prognosis of patients undergoing RC. Sarcopenia is an in dependent risk factor for 5-year OS and PFS. Our nomogram models demonstrated good predictive accuracy. Preoperative identification of muscle depletion and tailored interventions (exercise and nutrition) may improve postoperative outcomes.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 4","pages":"Article 102373"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization Patterns and Survival in Older Men With Metastatic Prostate Cancer Treated with Radium-223 in the United States: A SEER-Medicare Study","authors":"Bo Zhou ,&nbsp;Amit D. Raval ,&nbsp;Yifan Zhang ,&nbsp;Nethra Sambamoorthi ,&nbsp;Matthew J. Korn ,&nbsp;Niculae Constantinovici ,&nbsp;Rana McKay ,&nbsp;Usha Sambamoorthi","doi":"10.1016/j.clgc.2025.102372","DOIUrl":"10.1016/j.clgc.2025.102372","url":null,"abstract":"<div><h3>Introduction</h3><div>Previous research on Radium-223 treatment patterns in metastatic prostate cancer has been limited to select sites, oncology practices, or claims databases. Limited data exists on the use and outcomes of Radium-223 in Medicare population the largest public insurance provider for people aged 65 years and older in the United States. Therefore, this study used a nationwide population database of cancer registries linked to Medicare claims to examine Ra-223 treatment patterns, factors associated with treatment completion, and their associations with survival outcomes.</div></div><div><h3>Patients and Methods</h3><div>A retrospective cohort analysis was conducted on 1062 Medicare beneficiaries (≥ 66 years) with prostate cancer who initiated Ra-223 treatment between January 2016 and June 2020. Eligible men had 12 months of continuous Medicare Parts A/B/D enrollment prior to Ra-223 initiation and were followed for a minimum of 6 months. Primary outcomes included completion of ≥ 5 cycles of Ra-223 and overall survival. Factors influencing completion were analyzed with multivariate logistic regression, and survival was estimated using Kaplan-Meier and proportional hazards regressions.</div></div><div><h3>Results</h3><div>The cohort was 79.9% nonhispanic White, 6.8% Hispanic, and 6.1% nonhispanic Black, with a mean age of 75.6 years (SD = 6.6). Overall, 59.4% completed ≥ 5 cycles. Men receiving Ra-223 as first-line (21.1%) or second-line metastatic castration-resistant prostate cancer(mCRPC) therapy (44.1%) were more likely to complete treatment than those receiving third-line or later (aOR = 1.76,1.56, 95% CI, [1.22-2.54], [1.17-2.08]). Completing ≥ 5 cycles of Ra-223 was associated with longer survival (18.5 vs. 11.1 months, <em>P</em> &lt; .001; aHR = 0.51, 95% CI, [0.44, 0.59]), as was first- or second-line therapy use (18.4, 14.8 months vs. 13.8 months, <em>P</em> &lt; .001; aHR = 0.56,0.82; 95% CI, [0.45-0.68], [0.69-0.96]) compared to Ra-233 as third-line or later.</div></div><div><h3>Conclusion</h3><div>The majority of men received ≥ 5 cycles of Ra-223. Early initiation of Ra-223 was associated with higher completion rates and better survival outcomes, underscoring the importance of early Ra-223 use in managing mCRPC.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 4","pages":"Article 102372"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radical Prostatectomy Versus Radiation Therapy for Locally Advanced and Clinically Nodal Positive Prostate Cancer","authors":"Mike Wenzel ,&nbsp;Katrin Burdenski ,&nbsp;Nikolaos Tselis ,&nbsp;Claus Rödel ,&nbsp;Christian Brandts ,&nbsp;Marit Ahrens ,&nbsp;Jens Koellermann ,&nbsp;Markus Graefen ,&nbsp;Hans Heinzer ,&nbsp;Alexander Haese ,&nbsp;Clara Humke ,&nbsp;Carolin Siech ,&nbsp;Severine Banek ,&nbsp;Felix K.H. Chun ,&nbsp;Philipp Mandel","doi":"10.1016/j.clgc.2025.102370","DOIUrl":"10.1016/j.clgc.2025.102370","url":null,"abstract":"<div><h3>Introduction</h3><div>Radical prostatectomy (RP) and radiation therapy (RT) are both recommended as standard-of-care for advanced prostate cancer (aPCa). However, data on comparisons for aPCa are scant.</div></div><div><h3>Patients and Methods</h3><div>We relied on the University Cancer Center database to investigate outcomes in metastasis-free (MFS), cancer-specific (CSS) and overall survival (OS) of cT3-4 and cN1 RP versus RT-treated patients between 2014 and 2024.</div></div><div><h3>Results</h3><div>Of 1017 cT3-4 patients, 93% underwent RP, which were significantly younger (67 vs. 75 years) and harbored significantly lower PSA level (9.3 vs. 12.7 ng/ml). Moreover, significant higher rates of ISUP4-5 in RT patients were observed (51% vs. 37%, <em>P</em> = .001). Univariable MFS, CSS and OS outcomes did not differ for cT3-4 patients. In multivariable adjusted MFS, CSS and OS outcomes also no difference between RP vs. RT-treated cT3-4 patients were observed (all <em>P</em> &gt; .05). Of 239 cN1 patients, 87% underwent RP, which were also younger (66 vs. 73 years, <em>P</em> &lt; .001) and with clinically meaningful lower PSA level (15.4 vs. 29.0 ng/ml, <em>P</em> = .09), relative to RT patients. In univariable MFS analyses, RT provided better results, with no differences for CSS and OS. However, after multivariable adjustment MFS, CSS and OS analyses showed no significant differences between RP vs. RT-treated cN1 patients (all <em>P</em> &gt; .05).</div></div><div><h3>Conclusion</h3><div>Real-world evidence of currently RP vs. RT-treated locally advanced cT3-4 and clinically node-positive prostate cancer patients suggest equally efficient cancer-control outcomes such as MFS, CSS and OS when adjusting for different patient and tumor characteristics and show excellent cancer control rates in this very-high risk cohort.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 4","pages":"Article 102370"},"PeriodicalIF":2.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Rheumatoid Arthritis, Frailty Status, and Mortality in Older Adults with Bladder Cancer","authors":"Maya Swaminathan ,&nbsp;Sarah K Holt ,&nbsp;John L. Gore ,&nbsp;Yaw A. Nyame ,&nbsp;Jonathan Wright ,&nbsp;Ami Shah ,&nbsp;Jeffrey A. Sparks ,&nbsp;Una E. Makris ,&nbsp;Petros Grivas ,&nbsp;Maria Suarez-Almazor ,&nbsp;Sarah Psutka ,&nbsp;Namrata Singh","doi":"10.1016/j.clgc.2025.102369","DOIUrl":"10.1016/j.clgc.2025.102369","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the associations between rheumatoid arthritis (RA) and all-cause (ACM) and cancer-Specific mortality (CSM) in older adults with bladder cancer and examine how frailty may affect these associations.</div></div><div><h3>Methods</h3><div>Retrospective cohort study derived from the Surveillance Epidemiology and End Results (SEER) cancer registry and linked to Medicare claims data (SEER-Medicare). The cohort consisted of patients ≥ 65 years diagnosed with bladder cancer between 2004 and 2017. RA and frailty status were derived using validated administrative algorithms. ACM and CSM as derived from the SEER registry.</div></div><div><h3>Results</h3><div>Frailty modified the relationship between RA and mortality outcomes (interaction <em>P</em> value for ACM: .002 and for CSM: .007). We observed that RA was associated with a higher risk of CSM (aHR 1.17, 95% CI, 1.01-1.35) and ACM (aHR 1.12, 95% CI, 1.05-1.20) in nonfrail patients. In frail patients with bladder cancer, RA was not independently associated with CSM (aHR 0.81, 95% CI, 0.62-1.06) or ACM (aHR 0.93, 95% CI, 0.83-1.05).</div></div><div><h3>Conclusion</h3><div>Frailty is associated with adverse health outcomes. As people are living longer, it is becoming increasingly prevalent among patients with chronic conditions such as RA. We observed that RA is associated with increased risk of ACM and CSM among nonfrail older adults with bladder cancer. The lack of an association between RA and mortality in frail patients with RA suggests that the effect of frailty on mortality may overpower the effect that RA may exert—this information can help prognosticate outcomes in patients with bladder cancer, RA, and frailty.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 4","pages":"Article 102369"},"PeriodicalIF":2.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis, Treatment and Survival From Testicular Cancer: Real-World Data From the National Health Service England Between 2013 and 2020","authors":"Karl H. Pang ,&nbsp;Hussain M. Alnajjar ,&nbsp;Asif Muneer","doi":"10.1016/j.clgc.2025.102367","DOIUrl":"10.1016/j.clgc.2025.102367","url":null,"abstract":"<div><h3>Introduction</h3><div>The National Disease Registration Service (NDRS) collects and curates data on cancer diagnoses in England. This study analyzed testicular cancer (TC) data from 2013 to 2020.</div></div><div><h3>Patient and Methods</h3><div>Data were extracted from the NDRS “Get Data Out” database. The incidence per year, routes to diagnosis (RTD), treatment modalities and overall survival were analyzed.</div></div><div><h3>Results</h3><div>Between 2013 to 2020, 15,921 TC were diagnosed. The majority of cases were seminomatous germ cell tumors (SGCT) (61.4%), followed by nonseminomatous germ cell tumors (NSGCT) (33.6%). The annual incidence remained relatively stable, with 2010 cases in 2013 and 2023 cases in 2019. The majority of patients were ≥30 years (72.4%). Most cases (64%) were diagnosed with stage I disease, with a rising incidence observed in stage I NSGCTs. The primary RTD was the 2-week-wait (2ww) cancer pathway (59.1%), followed by GP referrals (15.7%) and emergency presentations (8.9%). A total of 90.4% of TC were treated with surgery, with or without chemotherapy, regardless of the histological subtype. Stage II-III disease more commonly underwent surgery combined with chemotherapy compared to stage I disease (65.7% vs. 46.8%, <em>P</em> &lt; .0001). The 12, 24, and 60-month survival was 98.0%, 96.9%, and 95.6% respectively. Stage I disease and SGCT were associated with better survival outcomes (<em>P</em> &lt; .001). Missing data from this dataset is a limitation.</div></div><div><h3>Conclusion</h3><div>The incidence of TC in England is relatively stable. Most TC were diagnosed via the 2ww cancer pathway. Surgery was the primary treatment modality and survival rates have remained relatively stable over time. Real-world data provide a cost-effective, time-efficient source of information to guide disease epidemiology, diagnostics, treatments, and outcomes.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 4","pages":"Article 102367"},"PeriodicalIF":2.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose-Dense Docetaxel and Radium-223 in Bone-Dominant Metastatic Castration-Resistant Prostate Cancer","authors":"Brendan Connell ,&nbsp;Clara Hwang ,&nbsp;Edmund Folefac ,&nbsp;Christian Lawlor ,&nbsp;Benjamin Koethe ,&nbsp;Paul Mathew","doi":"10.1016/j.clgc.2025.102368","DOIUrl":"10.1016/j.clgc.2025.102368","url":null,"abstract":"<div><h3>Background</h3><div>Disease progression in castration-resistant prostate cancer (CRPC) remains bone-dominant and docetaxel-responsive. Docetaxel and radium-223 would be a logical combination but myelosuppression is dose-limiting. Dose-dense schedules of docetaxel have comparable activity to bolus dosing with mitigated myelosuppression. We hypothesized that dose-dense docetaxel with standard radium-223 would be a feasible, safe and effective combination in bone-dominant metastatic CRPC.</div></div><div><h3>Methods</h3><div>Subjects had progressive bone-predominant CRPC. Design was dose escalation plus expansion with 28-day cycles. Docetaxel was given every 2 weeks in a 4-week lead-in, then with Radium-223 every 4 weeks up to 6 cycles. Dose-levels (DL) included 1: docetaxel 40 mg/m²; 1a: docetaxel 40 mg/m² with G-CSF on Day 16, 2a: docetaxel 50 mg/m² with G-CSF on Day 16. The maximum tolerated dose (MTD) was defined as the highest (DL) of docetaxel achieved without dose-limiting toxicity (DLT). Markers of safety and efficacy were annotated.</div></div><div><h3>Results</h3><div>Forty-three subjects were enrolled (NCT03737370). The patient population included 21% black, 9% Asians, 93% had prior intensified hormonal therapy, 67% had bone pain, and 76% had ≥ 4 bone metastases. Seven patients dropped out during the 4-week docetaxel lead in. Neutropenia at DL 1 limited combination therapy. No (DLT) occurred at DL 1a (<em>n</em> = 6) or DL 2a (<em>n</em> = 5). Twenty-two patients were enrolled to an expansion cohort with docetaxel 50 mg/m² with G-CSF on Day 16 (DL 2a), the designated MTD. Among 35 patients treated with the combination, there were no febrile neutropenia events. One patient had dose-limiting Grade 3 anemia. PSA50 response was 51.4% and PSA90 was 25.7%. Median progression-free survival was 11.7 months, and median overall survival was 20.1 months.</div></div><div><h3>Conclusions</h3><div>A lead-in cycle and a dose-dense schedule of docetaxel with G-CSF enabled the combination with radium-223 in standard dose-intensities with minimal hematological toxicity. The regimen will likely combine logically and safely with hormone-intensification for study in high-risk/high-volume castration-sensitive metastatic disease.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 4","pages":"Article 102368"},"PeriodicalIF":2.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Utility of Contemporary Community-Based Prostate Cancer Screening Campaigns","authors":"Nassib Abou Heidar,&nbsp;Zhe Jing,&nbsp;Richard Satterwhite,&nbsp;Bradley Webster,&nbsp;Eric C. Kauffman,&nbsp;Qiang Li,&nbsp;Khurshid A. Guru,&nbsp;Ahmed A. Hussein","doi":"10.1016/j.clgc.2025.102366","DOIUrl":"10.1016/j.clgc.2025.102366","url":null,"abstract":"<div><h3>Introduction</h3><div>While early detection of prostate cancer (PCa) might provide benefits in terms of PCa mortality, this might be associated with overdiagnosis and overtreatment of indolent cancers. We aimed to evaluate our community-based PCa early-detection campaigns.</div></div><div><h3>Methods</h3><div>A retrospective review of 19 PCa early-detection campaigns led by our institution was conducted between 2015 and 2023. These campaigns included PSA testing and digital rectal examinations (DRE) for all comers, followed by elective workup of at-risk patients, with follow-up PSA testing and multiparametric MRI (mpMRI). Data were reviewed for demographics and clinical parameters. Descriptive statistics were used to describe the data. Logistic regression was used to identify the factors associated with diagnosis of PCa.</div></div><div><h3>Results</h3><div>1171 men were included with median PSA of 1.1 ng/ml (IQR 0.6-2.5). Eighty seven men (7.4%) underwent prostate biopsy. Of those, 66 (76%) were diagnosed with prostate cancer (14% with Gleason grade group (GG) 1 and 86% with GG2 or higher—clinically significant prostate cancer (csPCa). Higher PSA (OR 1.62, 95% CI 1.42-1.85, <em>P</em> &lt; .0001) and suspicious DRE (OR 97, 95% CI 38-248, <em>P</em> &lt; .0001) were associated with diagnosis of csPCa. The number needed to screen to diagnose 1 case of PCa was 18 (95% CI 14-22) and the number needed to screen to diagnose 1 case of csPCa was 21 (95% CI 16-27).</div></div><div><h3>Conclusion</h3><div>Herein we describe our experience with contemporary PCa screening campaigns combining traditional screening with PSA and DRE with prostate MRI and judicious use of prostate biopsy.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 4","pages":"Article 102366"},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of Relapse Detection Methods in Stage 1 Testicular Germ Cell Tumors in Patients After Orchidectomy Managed With Active Surveillance: Is Physical Examination Required?","authors":"A.E. Smith ,&nbsp;R. Zielinski ,&nbsp;P. Grimison ,&nbsp;F. Honeyball","doi":"10.1016/j.clgc.2025.102365","DOIUrl":"10.1016/j.clgc.2025.102365","url":null,"abstract":"<div><h3>Background</h3><div>Active surveillance (AS) is the preferred management for most patients with stage 1 testicular germ cell tumors (GCT) after orchidectomy as it avoids chemotherapy in up to 85% of patients. International guidelines recommend a combination of imaging, serum tumor markers and physical examination. The aim of this review was to analyze the diagnostic yield of physical examination for detecting relapse in these patients.</div></div><div><h3>Methods</h3><div>Systematic review of the literature from 1976 to 2024 detailing method of relapse detection for patients with stage I GCT managed with AS. Studies commencing after 1990 were assigned to the ‘Modern Cohort’ and those prior to this date were assigned to the “Older Cohort.” Descriptive statistical analysis of discrete data was performed to determine recurrence and proportion of patients, where relevant. The chi squared test was used to determine statistical significance.</div></div><div><h3>Results</h3><div>Twenty articles were identified representing 2232 (20%) relapses amongst 11,414 patients managed with AS. Relapses were detected by imaging alone in 60%, tumor markers alone in 24%, imaging and markers in 15%, and physical examination in 1.5%. Comparing the Modern cohort (n = 4771) to the older cohort (n = 6643), there were fewer relapses detected by physical examination (0.3% vs. 2%, <em>P</em> = .01) and more relapses detected by imaging alone (71% vs. 55%, <em>P</em> &lt; .00001).</div></div><div><h3>Conclusions</h3><div>Almost all relapses are detected by routine imaging, serum tumor markers or a combination of these methods. Physical examination alone rarely identified relapses, particularly in the Modern cohort which we hypothesize was driven by improvement in imaging techniques. AS can be conducted safely without mandatory physical examination.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 4","pages":"Article 102365"},"PeriodicalIF":2.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Genomic Classifiers and Nonsuspicious Magnetic Resonance Imaging Findings in Predictive Modelling for Lymph Node Metastasis in Patients With Localized Prostate Cancer","authors":"Vinayak G. Wagaskar ,&nbsp;Ashutosh Maheshwari ,&nbsp;Osama Zaytoun ,&nbsp;Yashaswini Agarwal ,&nbsp;Kaushik P. Kolanukuduru ,&nbsp;Neeraja Tillu ,&nbsp;Manish K. Choudhary ,&nbsp;Ash K. Tewari","doi":"10.1016/j.clgc.2025.102364","DOIUrl":"10.1016/j.clgc.2025.102364","url":null,"abstract":"<div><h3>Objectives</h3><div>To develop and validate model predicting lymph node involvement(LNI) in men undergoing radical prostatectomy with/without suspicious magnetic resonance imaging(MRI) with/without genomic classifiers (GC).</div></div><div><h3>Methods</h3><div>Retrospective analysis of patients that underwent extended pelvic lymphadenectomy(ePLND) during robot-assisted radical prostatectomy(RARP). ePLND was defined as removal of obturator, internal and external iliac and distal part of common iliac lymph nodes. Based on preoperative work-up, imaging, and GC testing, we stratified patients into three cohorts. Cohort I with suspicious MRI (<em>n</em> = 2172), cohort II with nonsuspicious MRI (<em>n</em> = 1233) and cohort III with GC irrespective of MRI findings (<em>n</em> = 1003). Logistic regression analysis performed to create nomogram for predicting LNI. Receiver operative characteristics (ROC) and decision curve analysis (DCA) were performed to evaluate net benefit. Statistical analyses were performed using R 4.3.3. We also utilized artificial neural network (ANN) for calculating LNI risk by using binary classification model.</div></div><div><h3>Results</h3><div>Overall 138 (6.4%), 49 (3.9%) and 69 (6.8%) patients had LNI in cohort I,II and III respectively. Multivariable analysis showed prostate specific antigen (PSA), biopsy Gleason Grade Group (GGG), number of positive cores, MRI LNI were significant predictors of LNI in all cohorts; MRI lesion size, MRI T stage (cohort I), MRI prostate volume (cohort II) and biopsy GC (cohort III) were significant. ROC for predicting LNI were 0.92, 0.84 and 0.91 for cohort I,II and III respectively. Using the ANN, we calculated ROC curves were 0.90,0.82 and 0.91 for cohort I, II and III, respectively. DCA showed a clinical benefit for the model detection of LN metastases for each cohort.</div></div><div><h3>Conclusions</h3><div>We developed the nomogram that integrate clinical, radiological, histological and genomic parameters to predict lymph node metastases during prostatectomy. This will avoid unnecessary lymphadenectomy at cost of missing of few metastases.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 4","pages":"Article 102364"},"PeriodicalIF":2.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Sensitivity and Specificity of Total Prostate Specific Antigen in the Diagnosis of Prostate Cancer in a Resource-Limited African Setting: A 5-Year Review in a Kenyan Hospital","authors":"Chinonso P. Shu ,&nbsp;Tsamayem G.T. Sop ,&nbsp;Tanyi J. Tanyi ,&nbsp;Somo J. Lambi ,&nbsp;Ndonku A. Signang ,&nbsp;P. Irungu Juma","doi":"10.1016/j.clgc.2025.102363","DOIUrl":"10.1016/j.clgc.2025.102363","url":null,"abstract":"<div><h3>Introduction</h3><div>Prostate cancer (CaP) is the most common cancer in males. With rising life expectancy, CaP incidence is increasing. There is a drift from the use of total prostate specific antigen (tPSA) to other PSA parameters for screening. However, theseparameters are not readily available in resource-limited settings.</div></div><div><h3>Objective</h3><div>To evaluate the sensitivity and specificity of tPSA to make the diagnosis of CaP in an African population.</div></div><div><h3>Methodology</h3><div>This was a 5-year retrospective review at the AIC Kijabe hospital between January 2018 to December 2022. We included all records of patients treated for prostate disease who had a prostate biopsy and excluded records of patients who had been on a 5-alpha reductase inhibitor or alphablocker and those with urinary tract infection. We used tPSA cut-offs of 4, 10, 20 and 100 ng/ml to calculate sensitivity and specificity.</div></div><div><h3>Results</h3><div>We included 710 records, of which CaP was the histopathological diagnosis in 327 (46.1%). The mean tPSA was 69.70 ± 2.9 ng/mL. Serum tPSA sensitivity and NPV to diagnose CaP dropped from 99.4% and 96.6% respectively at tPSA ≥ 4 to 59.3% and 72.7% respectively at a tPSA ≥ 100. The specificity and PPV rose from 14.9% and 49.9% respectively at tPSA ≥ 4 to 92.4% and 87.0% at tPSA ≥ 100.</div></div><div><h3>Conclusion</h3><div>In resource-limited settings, tPSA is still a good screening tool for CaP, with cost-effective PSA cut-off ≥ 10 ng/mL for further investigations. PSA ≥ 100 ng/ml is almost always CaP until proven otherwise.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"23 4","pages":"Article 102363"},"PeriodicalIF":2.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}