Current Opinion in Urology最新文献

Novel intravesical delivery systems for nonmuscle invasive bladder cancer. 新型膀胱内给药系统治疗非肌肉浸润性膀胱癌。

IF 2.1 3区医学

Current Opinion in Urology Pub Date : 2025-07-17 DOI: 10.1097/MOU.0000000000001326

Alessandro Uleri, Olga Katzendorn, Zine Eddine Khene, Evanguelos Xylinas, Felix-Guerrero Ramos, Benjamin Pradere

{"title":"Novel intravesical delivery systems for nonmuscle invasive bladder cancer.","authors":"Alessandro Uleri, Olga Katzendorn, Zine Eddine Khene, Evanguelos Xylinas, Felix-Guerrero Ramos, Benjamin Pradere","doi":"10.1097/MOU.0000000000001326","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001326","url":null,"abstract":"Purpose of review: Nonmuscle invasive bladder cancer (NMIBC) represents approximately 75% of bladder cancer cases at diagnosis and poses a significant management challenge due to high recurrence rates and risk for progression. Conventional intravesical therapies face limitations including suboptimal drug delivery, mucosal exposure time and significant adverse events. This review provides a timely assessment of novel intravesical delivery systems developed to overcome these limitations and improve oncological outcomes for patients with NMIBC.Recent findings: Several innovative delivery systems show promising results. Hyperthermic intravesical chemotherapy (HIVEC) demonstrates its efficacy in selected high-risk NMIBC. Intravesical drug-releasing systems (iDRS) like TAR-200 showed complete response rates up to 84% in BCG-unresponsive disease, while TAR-210 shows promise for FGFR-altered NMIBC. UGN-102, a reverse thermal gel containing mitomycin C, achieves 65-79% complete response rates in low-grade intermediate-risk NMIBC. Oncofid-P-B, combining paclitaxel with hyaluronic acid, demonstrates efficacy in BCG-unresponsive CIS.Summary: Novel intravesical delivery systems show to enhance drug retention, improve tissue penetration, and potentially reduce adverse events. While traditional chemotherapy or BCG remain the gold-standard adjuvant treatments for NMIBC, these novel approaches offer promising alternatives for selected patients pending on ongoing clinical validation.","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648803","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}

引用次数: 0

Integration of prostate-specific membrane antigen-PET and multiparametric MRI for gross tumour volume definition in localised and locally advanced prostate cancer treated with image-guided radiotherapy. 结合前列腺特异性膜抗原- pet和多参数MRI对图像引导放疗治疗的局部和局部晚期前列腺癌的大体肿瘤体积定义。

IF 2.1 3区医学

Current Opinion in Urology Pub Date : 2025-07-16 DOI: 10.1097/MOU.0000000000001321

Tessa D van Bergen, Arthur J A T Braat, Cornelis A T van den Berg, Timo F W Soeterik

{"title":"Integration of prostate-specific membrane antigen-PET and multiparametric MRI for gross tumour volume definition in localised and locally advanced prostate cancer treated with image-guided radiotherapy.","authors":"Tessa D van Bergen, Arthur J A T Braat, Cornelis A T van den Berg, Timo F W Soeterik","doi":"10.1097/MOU.0000000000001321","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001321","url":null,"abstract":"Purpose of review: This review evaluates recent evidence on the utility of multiparametric MRI (mpMRI), prostate-specific membrane antigen (PSMA) PET, and their combined application for accurately delineating the intraprostatic gross tumour volume (GTV) in patients with primary localised and locally advanced prostate cancer. It further explores the impact of GTV-based dose escalation on treatment-related toxicity and clinical outcomes.Recent findings: Recent studies suggest that combining PSMA-PET with mpMRI enhances lesion coverage of clinically significant, histopathologically verified intraprostatic tumours and yields higher interobserver agreement. However, this improved sensitivity is offset by reduced specificity, and it remains uncertain whether expanding the GTV to include additional PSMA-PET-defined regions impacts long-term treatment-related toxicity or improves oncological outcomes. Multiple phase I/II trials using PSMA-PET and mpMRI have reported acceptable acute and late toxicity profiles. Nevertheless, extensive data on long-term toxicity and disease outcomes following PSMA-PET-guided interventions remain limited, warranting further investigation to assess its impact.Summary: The combination of mpMRI and PSMA-PET has been shown to improve coverage of dominant intraprostatic lesion and reduce interobserver variability. While GTVs derived from combined imaging modalities are typically larger than those based on mpMRI alone, hypofractionated focal boost treatments targeting PSMA-PET/mpMRI-defined GTVs have demonstrated acceptable acute toxicity profiles. More data are needed to determine the impact of PSMA-PET expanded GTVs on long-term clinical outcomes.","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642051","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}

引用次数: 0

Intravesical chemotherapy combination treatments for BCG-unresponsive nonmuscle invasive bladder cancer. 膀胱内化疗联合治疗bcg无反应的非肌肉浸润性膀胱癌。

IF 2.1 3区医学

Current Opinion in Urology Pub Date : 2025-07-15 DOI: 10.1097/MOU.0000000000001324

Paolo Zaurito, Pietro Scilipoti, Francesco Montorsi, Alberto Briganti, Marco Moschini

{"title":"Intravesical chemotherapy combination treatments for BCG-unresponsive nonmuscle invasive bladder cancer.","authors":"Paolo Zaurito, Pietro Scilipoti, Francesco Montorsi, Alberto Briganti, Marco Moschini","doi":"10.1097/MOU.0000000000001324","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001324","url":null,"abstract":"Purpose of review: There is an increasing interest in developing bladder sparing therapies (BSTs) for patients with Bacillus Calmette-Guérin unresponsive (U-BCG) nonmuscle invasive bladder cancer (NMIBC) as an alternative to radical cystectomy (RC). We aimed to perform a review of efficacy and safety of intravesical chemotherapy combination treatments for U-BCG NMIBC patients according to the most recent evidence.Recent findings: The use of intravesical chemotherapy combination treatments for U-BCG patients has shown promising efficacy and tolerability especially in retrospective series. For U-BCG patients, the most used option in this context is intravesical gemcitabine plus docetaxel, with a 2-year recurrence free-survival ranging between 37-62%, and a 2-year progression free-survival rate of 70-95%, with grade 3-5 adverse events (AEs) varying between 3-8% according to the most recent reports. Other studies are investigating the combination of more than two chemotherapy agents, with a recent prospective trial showing encouraging results for the combination of three intravesical drugs (gemcitabine, cabazitaxel, cisplatin) with a cystectomy-free survival rate of 97% at 1-year and no evidence of grade 3-5 AEs at a median follow-up of 20 months.Summary: Recent evidence on intravesical chemotherapy combination treatment for U-BCG NMIBC is mostly based on retrospective studies, especially those investigating gemcitabine/docetaxel. However, some studies are currently investigating the combination of more than two chemotherapy agents. Overall, studies show good short-term efficacy, acceptable rates of disease progression, and tolerability in patients with U-BCG NMIBC. Nevertheless, prospective studies will be needed to support the widespread use of new BSTs as valid alternatives to RC in patients who failed BCG.","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636501","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}

引用次数: 0

The role of radiotherapy in pelvic nodal recurrence following definitive treatment for prostate cancer. 放疗在前列腺癌明确治疗后盆腔淋巴结复发中的作用。

IF 2.1 3区医学

Current Opinion in Urology Pub Date : 2025-07-14 DOI: 10.1097/MOU.0000000000001322

Alessandro Dematteis, Marcin Miszczyk, Angelo Cormio, Akihiro Matsukawa, Paolo Gontero, Shahrokh F Shariat

{"title":"The role of radiotherapy in pelvic nodal recurrence following definitive treatment for prostate cancer.","authors":"Alessandro Dematteis, Marcin Miszczyk, Angelo Cormio, Akihiro Matsukawa, Paolo Gontero, Shahrokh F Shariat","doi":"10.1097/MOU.0000000000001322","DOIUrl":"10.1097/MOU.0000000000001322","url":null,"abstract":"Purpose of review: To summarize recent evidence on the role of radiotherapy in managing pelvic lymph node (PLN) recurrence following curative-intent primary therapy for prostate cancer (PCa), focusing on radiotherapy strategies, novel medical imaging, and oncological outcomes.Recent findings: Prostate-specific membrane antigen PET (PSMA-PET) has improved accuracy of staging in patients with PCa; however, more often than not, it fails to correctly identify PLN metastases, and the impact on clinical outcomes of the patients is uncertain. Metastasis-directed therapies (MDT) combined with short-term androgen-deprivation therapy (ADT) in patients with PLN recurrence are associated with a significantly higher risk of recurrence compared to more comprehensive approaches. Emerging data support the role of elective nodal radiotherapy (ENRT) combined with short-term androgen deprivation therapy (ADT) and radiotherapy boost to the PLN metastases to enhance disease control. Notably, despite treating a more extensive pelvic region than MDT, ENRT does not appear to significantly increase acute toxicity or negatively impact quality of life (QoL). Recent evidence suggests a role for androgen receptor pathway inhibitors (ARPI), such as enzalutamide, in patients with high-risk biochemical recurrence, introducing a new treatment paradigm for patients ineligible for salvage radiotherapy. Ongoing prospective studies are refining the role of radiotherapy in combination with systemic treatments.Summary: Despite PSMA-PET allowing for improved staging and better patient-tailored decisions, patients with PLN recurrence continue to benefit from comprehensive multimodal treatment approach. Elective PLN irradiation combined with radiotherapy boost and ADT lead to improved disease control, without compromising safety and toxicity. ARPI+ADT and ARPI-monotherapy emerge as alternatives for select patients.","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625578","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}

引用次数: 0

Traditional and next-generation bacillus Calmette-Guérin based treatment strategies for bacillus Calmette-Guérin unresponsive non-muscle-invasive bladder cancer in the era of emerging therapies. 传统和新一代基于calmette - gusamrin芽孢杆菌的治疗策略在新兴疗法时代对calmette - gusamrin无反应的非肌肉侵袭性膀胱癌。

IF 2.1 3区医学

Current Opinion in Urology Pub Date : 2025-07-14 DOI: 10.1097/MOU.0000000000001319

Alberto Artiles Medina, José Daniel Subiela, Renate Pichler, Felix Guerrero-Ramos, Francisco Javier Burgos Revilla

{"title":"Traditional and next-generation bacillus Calmette-Guérin based treatment strategies for bacillus Calmette-Guérin unresponsive non-muscle-invasive bladder cancer in the era of emerging therapies.","authors":"Alberto Artiles Medina, José Daniel Subiela, Renate Pichler, Felix Guerrero-Ramos, Francisco Javier Burgos Revilla","doi":"10.1097/MOU.0000000000001319","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001319","url":null,"abstract":"Purpose of review: Bacillus Calmette-Guérin (BCG) remains the standard of care for high-risk non-muscle-invasive bladder cancer (NMIBC), yet up to 40-50% of patients experience treatment failure, leaving limited alternatives to avoid radical cystectomy. This narrative review critically examines both traditional and emerging BCG-based strategies - including repeat induction and modern combination regimens - for patients with BCG-unresponsive NMIBC.Recent findings: BCG monotherapy after BCG failure has shown limited effectiveness, with recent studies reporting 12-month disease-free survival (DFS) rates of 60-70%. Nonetheless, BCG continues to serve as an immunotherapeutic backbone in combination strategies. Chemo-immunotherapy regimens, particularly those using gemcitabine or mitomycin C, have achieved 1-year DFS rates of up to 80%. Combinations with cytokines and immunocytokines - such as interferon-α or nogapendekin alfa inbakicept-pmln (NAI) - have demonstrated DFS rates of 45-61%, and NAI has recently received FDA approval. Immune checkpoint inhibitors (e.g., pembrolizumab, durvalumab, atezolizumab) in combination with BCG have shown DFS rates ranging from 42 to 73% at 12 months. However, many studies are limited by small sample sizes and heterogeneous designs.Summary: Despite its limited efficacy as monotherapy in unresponsive cases, BCG retains therapeutic relevance as part of combination strategies that enhance its immunologic activity. Emerging data suggest that these BCG-based regimens offer a promising, bladder-sparing alternative for patients who are ineligible for or decline radical cystectomy. Ongoing and future trials will be essential to define optimal combinations and identify which patients are most likely to benefit, thereby enabling appropriate patient selection.","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625579","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}

引用次数: 0

Treatment of biochemical recurrence after primary therapy with curative intent. 以治愈为目的治疗初次治疗后的生化复发。

IF 2.1 3区医学

Current Opinion in Urology Pub Date : 2025-07-08 DOI: 10.1097/MOU.0000000000001312

Navid Roessler, Marcin Miszczyk, Nadja Strewinsky, Paweł Rajwa, Shahrokh F Shariat

{"title":"Treatment of biochemical recurrence after primary therapy with curative intent.","authors":"Navid Roessler, Marcin Miszczyk, Nadja Strewinsky, Paweł Rajwa, Shahrokh F Shariat","doi":"10.1097/MOU.0000000000001312","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001312","url":null,"abstract":"Purpose of review: We aimed to summarize the recent advancements in management of biochemical recurrence (BCR) after primary curative therapy for prostate cancer (PCa), and the role of advanced imaging technologies in guiding and improving treatment decisions.Recent findings: Recent studies have reshaped the approach to managing BCR after primary treatment for PCa. A key shift is the preference for early salvage radiotherapy (sRT), which has proven to offer comparable or even superior outcomes to immediate adjuvant therapy when closely monitored for progression. PSA kinetics (PSA doubling time) continue to guide treatment decisions, together with the time to PSA rise, Gleason Grade of the original tumor, and PSMA-PET imaging at the time of recurrence. While PSMA-PET significantly enhances the precision of recurrence detection, its sensitivity for smaller pelvic lymph node metastases remains limited, underscoring the need for careful consideration of all factors together to develop a risk-based consulting for all individualized treatment plan integrating patient wishes and health.Summary: Recent studies underscore the efficacy of early sRT in managing BCR, with PSA kinetics and ISUP score as a crucial factor in guiding treatment decisions. Furthermore, the integration of PSMA-PET imaging has improved the precision of recurrence detection, facilitating more tailored and effective treatment strategies for patients with BCR. We are finally entering the age of personalized, risk-based, patient-centred case delivery, where treatment of the primary tumor with curative intent is offered to patients with BCR.","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583345","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}

引用次数: 0

What's in a name? Why differentiation between biochemical recurrence and metastatic prostate cancer matters. 名字里有什么？为什么区分生化复发和转移性前列腺癌很重要。

IF 2.1 3区医学

Current Opinion in Urology Pub Date : 2025-07-08 DOI: 10.1097/MOU.0000000000001317

Anael S Rizzo, Pratik Kanabur, Adam B Weiner

{"title":"What's in a name? Why differentiation between biochemical recurrence and metastatic prostate cancer matters.","authors":"Anael S Rizzo, Pratik Kanabur, Adam B Weiner","doi":"10.1097/MOU.0000000000001317","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001317","url":null,"abstract":"Purpose of review: The natural history of biochemical recurrence (BCR) is highly variable, complicating the distinction between BCR and metastasis. A targeted approach to risk stratifying disease progression is needed. This review proposes a 'framework,' that categorizes disease progression into five distinct groups: low-risk BCR, high-risk BCR, oligometastatic disease, low-volume metastatic disease, and high-volume metastatic disease. Each group is defined by clinicopathological and molecular features, along with targeted treatment strategies to tailor therapy and optimize disease management.Recent findings: Recent clinical trials and updates to guidelines have focused on treatment intensification and early identification of patients at risk for recurrence. In addition, the utilization of molecular imaging and implementation of metastasis directed therapy has led to a change in the conventions of recurrence and metastasis. Therefore, the patients with BCR or metastatic disease require a more individualized and multimodal treatment for their prostate cancer.Summary: Distinguishing BCR from metastatic disease has important implications. It offers ways to avoid unnecessary treatment in patients who are less likely to progress and helps identify those who are more likely to benefit from earlier or more aggressive interventions.","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583346","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}

引用次数: 0

MR-guided radiotherapy for prostate cancer: an inevitable transition? 磁共振引导放射治疗前列腺癌：不可避免的过渡？

IF 2.1 3区医学

Current Opinion in Urology Pub Date : 2025-07-07 DOI: 10.1097/MOU.0000000000001315

Rafał Stando, Grzegorz Chmielewski

{"title":"MR-guided radiotherapy for prostate cancer: an inevitable transition?","authors":"Rafał Stando, Grzegorz Chmielewski","doi":"10.1097/MOU.0000000000001315","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001315","url":null,"abstract":"Purpose of review: The rising global incidence of prostate cancer has intensified both clinical and economic pressures to optimize radiotherapy (RT) delivery. Advances in imaging and fractionation - particularly magnetic resonance imaging (MR)-guided workflows and stereotactic body RT (SBRT) - aim to reduce treatment duration and minimize toxicity. This review explores these innovations and their potential inclusion into routine clinical practice.Recent findings: MR-guided RT (MRgRT) planning and delivery offer superior soft tissue contrast and real-time motion tracking, enabling reduced target margins and improved sparing of adjacent normal tissues. Hypofractionated regimens (e.g., 60 Gy in 20 fractions) have become standard, while ultra-hypofractionated SBRT (up to 12 Gy per fraction over 2-5 sessions) is gaining traction due to MRgRT capabilities. Adaptive RT allows for daily modification of treatment plans, based on real-time imaging. Several trials, including MIRAGE and SCIMITAR, have demonstrated reductions in acute genitourinary and gastrointestinal toxicity with MR-guided SBRT. Ongoing clinical trials and the MOMENTUM registry aim to clarify long-term outcomes and contribute to the standardization of MRgRT workflows.Summary: Based on available, preliminary evidence, MRgRT and adaptive SBRT are associated with a promising toxicity profiles. Nonetheless, further multicenter studies with extended follow-up are needed to validate outcomes and establish practice guidelines.","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574948","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}

引用次数: 0

Ultra-hypofractionation for the treatment of macroscopic prostate bed recurrence: a focus on stereotactic radiotherapy and brachytherapy. 超低分割治疗宏观前列腺床复发：立体定向放疗和近距离治疗的重点。

IF 2.1 3区医学

Current Opinion in Urology Pub Date : 2025-07-07 DOI: 10.1097/MOU.0000000000001314

Magdalena Stankiewicz, Wojciech Majewski

{"title":"Ultra-hypofractionation for the treatment of macroscopic prostate bed recurrence: a focus on stereotactic radiotherapy and brachytherapy.","authors":"Magdalena Stankiewicz, Wojciech Majewski","doi":"10.1097/MOU.0000000000001314","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001314","url":null,"abstract":"Purpose of review: The aim of this review is to assess contemporary studies on ultra-hypofractionated local salvage therapies - stereotactic body radiation therapy (SBRT) and brachytherapy - for macroscopic prostate bed recurrence after radical prostatectomy, with or without prior external beam radiotherapy (EBRT), and to highlight knowledge gaps guiding current trials.Recent findings: Recent studies, primarily retrospective, report 1-year biochemical control rates of 56-88% for SBRT and up to 87% for high-dose-rate brachytherapy, with low to moderate rates of severe genitourinary toxicity. Higher biologically effective doses and limited tumour volume predict improved outcomes, yet focal-only strategies carry some risk of out-of-field relapse within the prostate bed. The role of concomitant androgen deprivation therapy remains unclear. Several phase II trials (e.g. STARR, PROSTARE, REPAIR, and HypoFocal SRT) are underway.Summary: Ultra-hypofractionated salvage radiotherapy offers effective disease control with manageable toxicity for selected patients and may defer systemic therapy. Further studies are needed to standardize imaging, biopsy confirmation, dose escalation, and systemic treatment integration. Prospective, randomized studies are crucial to define optimal modality, target volume, and patient selection criteria before widespread adoption.","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574950","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}

引用次数: 0

Should we redefine the Phoenix criteria for biochemical recurrence after primary radiotherapy? 是否应该重新定义初次放疗后生化复发的凤凰标准？

IF 2.1 3区医学

Current Opinion in Urology Pub Date : 2025-07-07 DOI: 10.1097/MOU.0000000000001313

Ugo Giovanni Falagario, Francesco Pellegrino, Peter Wiklund

{"title":"Should we redefine the Phoenix criteria for biochemical recurrence after primary radiotherapy?","authors":"Ugo Giovanni Falagario, Francesco Pellegrino, Peter Wiklund","doi":"10.1097/MOU.0000000000001313","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001313","url":null,"abstract":"Purpose of review: The Phoenix criteria, which define biochemical recurrence (BCR) after radiotherapy as a prostate specific antigen (PSA) rise of at least 2 ng/ml above nadir, were developed to improve consistency in outcome reporting and distinguish genuine cancer recurrence from transient, noncancerous PSA fluctuations, commonly referred to as PSA \"bounces\". However, in the current era of advanced imaging and precision oncology, this definition is increasingly viewed as inadequate. This review critically examines recent evidence challenging the clinical utility of the Phoenix definition and explores potential alternatives that better reflect disease biology and patient outcomes.Recent findings: Modern imaging techniques, particularly prostate-specific membrane antigen (PSMA) PET/computed tomography (CT), have demonstrated the ability to detect recurrent prostate cancer at PSA levels well below the Phoenix threshold, allowing for earlier salvage interventions. Additionally, PSA kinetics such as nadir levels and doubling time provide superior prognostic information compared to static PSA thresholds. Multiparametric risk models that also incorporate PSMA PET/CT findings, PSA kinetics and clinical features may enable more accurate stratification of patients into low-risk and high-risk BCR categories. This evolving approach supports the notion that early, risk-adapted treatment can improve outcomes in high-risk patients, while reducing overtreatment in those at low risk.Summary: The Phoenix criteria no longer align with the capabilities of current diagnostic and prognostic tools. Redefining BCR using dynamic PSA metrics and advanced imaging could facilitate timely salvage treatment in patients at a high risk and allow surveillance strategies in those unlikely to progress. Prospective validation is warranted to inform future clinical guidelines.","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574949","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}

引用次数: 0