Current Opinion in Urology最新文献

{"title":"Toxicities of PARP inhibitors in genitourinary cancers.","authors":"János Szalontai, Tibor Szarvas, Marcin Miszczyk, Péter Nyirády, Shahrokh F Shariat, Tamás Fazekas","doi":"10.1097/MOU.0000000000001297","DOIUrl":"10.1097/MOU.0000000000001297","url":null,"abstract":"<p><strong>Purpose of review: </strong>Recent advancements in the understanding of the genetic background of genitourinary cancers allowed for a successful introduction of targeted antitumor agents to prostate cancer (PCa) treatment. Inhibitors of the poly ADP-ribose polymerase enzyme (PARPi) transformed the treatment landscape of metastatic prostate cancer, and being increasingly studied in earlier disease stages. However, they are associated with nonnegligible toxicity, therefore, we aimed to summarize their side-effect profile in patients with PCa.</p><p><strong>Recent findings: </strong>Hematologic toxicities, particularly anemia, thrombocytopenia, and neutropenia are among the most common and serious adverse events associated with PARPi, highlighting the need for regular blood count monitoring. Nonhematologic side effects, including fatigue, nausea, vomiting, diarrhea, and constipation, are common, and can be mitigated with supportive interventions like dietary modifications, antiemetics, or stool management techniques. Special attention should be given to patients with therapy-resistant or persistent cytopenia, in whom bone marrow biopsy should be considered, as it can indicate myelodysplastic syndrome and acute myeloid leukemia.</p><p><strong>Summary: </strong>PARP inhibitors represent a major advancement in the management of metastatic prostate cancer, offering a significant survival benefit in applicable cases. However, patients need to be carefully selected and informed, to allow for optimal balancing between the benefits and nonneglectable risks of severe toxicities. Better understanding of PARPi toxicity profile can improve personalized decision-making and enhance treatment compliance, through raising patients' awareness about the possible side effects of PARPi.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"467-471"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognostic role of prostate MRI in prostate cancer patients.","authors":"Paolo Zaurito, Armando Stabile, Francesco Montorsi, Alberto Briganti, Giorgio Gandaglia","doi":"10.1097/MOU.0000000000001288","DOIUrl":"10.1097/MOU.0000000000001288","url":null,"abstract":"<p><strong>Purpose of review: </strong>Multiparametric MRI (mpMRI) has been included in the diagnostic pathway of prostate cancer (PCa). However, the role of this imaging modality in predicting clinical outcomes after diagnosis has been poorly addressed so far. This review aims to summarize the most relevant updates on the prognostic role of mpMRI.</p><p><strong>Recent findings: </strong>Baseline mpMRI features help to predict adverse pathology at radical prostatectomy (RP) and grade reclassification during active surveillance. Parameters derived at prostate mpMRI such as PI-RADS score 4-5, the maximum diameter of the index lesion and the presence of extracapsular invasion/seminal vesicle invasion are among the strongest predictors of biochemical recurrence (BCR) for men treated with RP. mpMRI-based predictive models can achieve similar accuracy for BCR prediction when compared with validated models that relied on final pathology. Moreover, the use of mpMRI findings to predict disease recurrence after radiotherapy or focal therapy seems to optimize patient's risk stratification after treatment, ruling out disease recurrence.</p><p><strong>Summary: </strong>Clinicians should account for prostate mpMRI findings when predicting clinical outcomes in patients diagnosed with PCa.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"418-425"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990166","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":"Prostate-specific antigen doubling time in prostate cancer: a review of calculation methods and clinical implications.","authors":"Alfonso Romero Crespo, Daniel Carrasco Gomez, Nestor Manuel Sanchez Martinez, Carlos Bautista Vidal, Lydia Flores Sirvent, Rodrigo España Navarro, Emilio Garcia Galisteo","doi":"10.1097/MOU.0000000000001303","DOIUrl":"10.1097/MOU.0000000000001303","url":null,"abstract":"<p><strong>Purpose of review: </strong>Prostate-specific antigen doubling time (PSADT) is a key prognostic marker in prostate cancer, especially in cases of biochemical recurrence. It guides risk stratification and therapeutic decisions, but its calculation varies significantly across institutions. This review addresses the clinical relevance of PSADT and the need for standardized methods.</p><p><strong>Recent findings: </strong>Multiple models exist for PSADT calculation, including logarithmic regression, linear models, and nadir subtraction. Logarithmic regression best reflects PSA's exponential growth but requires at least three PSA values over time. Measurement variability - due to assay differences or sampling intervals - can affect PSADT estimates by 15-40%, impacting treatment decisions. Correction tools like the Memorial Sloan Kettering Cancer Center's Excel calculator have reduced variability by up to 30-40%, improving reliability.</p><p><strong>Summary: </strong>PSADT remains a valuable tool in prostate cancer management, particularly for guiding salvage therapies in biochemical recurrence. However, its accuracy depends on the calculation method and PSA measurement quality. Integrating validated tools like the MSKCC calculator and adopting standardized approaches can enhance clinical decision-making. This review underscores the need for improved harmonization of PSADT methodology across guidelines and clinical settings.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"447-452"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076674","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":"Redefining prostate cancer care: innovations and future directions in active surveillance.","authors":"Magdalena Koett, Felix Melchior, Nastasiia Artamonova, Jasmin Bektic, Isabel Heidegger","doi":"10.1097/MOU.0000000000001268","DOIUrl":"10.1097/MOU.0000000000001268","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides a critical analysis of recent advancements in active surveillance (AS), emphasizing updates from major international guidelines and their implications for clinical practice.</p><p><strong>Recent findings: </strong>Recent revisions to international guidelines have broadened the eligibility criteria for AS to include selected patients with ISUP grade group 2 prostate cancer. This adjustment acknowledges that certain intermediate-risk cancers may be appropriate for AS, reflecting a heightened focus on achieving a balance between oncologic control and maintaining quality of life by minimizing the risk of overtreatment.</p><p><strong>Summary: </strong>This review explores key innovations in AS for prostate cancer, including multi parametric magnetic resonance imaging (mpMRI), genomic biomarkers, and risk calculators, which enhance patient selection and monitoring. While promising, their routine use remains debated due to guideline inconsistencies, cost, and accessibility. Special focus is given to biomarkers for identifying ISUP grade group 2 cancers suitable for AS. Additionally, the potential of artificial intelligence to improve diagnostic accuracy and risk stratification is examined. By integrating these advancements, this review provides a critical perspective on optimizing AS for more personalized and effective prostate cancer management.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"439-446"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440170","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":"Current clinical evidence in intrarenal temperature, pressure and suction during retrograde intrarenal surgery: a review of literature.","authors":"Theodoros Tokas, Vineet Gauhar, Steffi Kar Kei Yuen, Bhaskar Kumar Somani","doi":"10.1097/MOU.0000000000001270","DOIUrl":"10.1097/MOU.0000000000001270","url":null,"abstract":"<p><strong>Purpose of review: </strong>Experimental evidence suggests that intrarenal temperatures (IRTs) and pressures (IRPs) during retrograde intrarenal surgery (RIRS) with laser lithotripsy are clinically significant. Suction devices aim to facilitate RIRS and improve procedure outcomes. We present an overview of new clinical studies regarding IRT, IRP, and suction developments.</p><p><strong>Recent findings: </strong>High laser power, low irrigation, and restricted working space were directly correlated with increased IRTs. Increased irrigation flow rate and ureteral access sheath (UAS) maintained well tolerated IRTs. Baseline IRPs ranged from 16 to 17 mmHg. Intraoperative IRP monitoring maintained values below 22 mmHg. Hand-assisted pumps often increase IRPs above the safety threshold. Prolonged IRP increments were correlated to postoperative infections. Suction devices decreased operative time to less than 60 min and improved stone-free rates (SFRs) at 1 day to more than 80 and at 30 days to more than 90%.</p><p><strong>Summary: </strong>Despite the limited clinical evidence, IRTs during RIRS correlate directly with laser power and reversely correlate with irrigation flow rate and UAS use. Intraoperative IRP monitoring prevents hazardous increments. Manual pump irrigation causes extremely high IRPs. There is a possible relation between prolonged IRP increments and infectious complication development. Using suction UAS or flexible and navigable sheaths (FANS) improves operative times and SFRs, while more studies regarding direct in-scope suction (DISS) efficiency and safety are needed.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"390-398"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457187","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":"Measuring, monitoring and reporting intrarenal pressure: a practical guide to endourologists from section of EAU Endourology.","authors":"Steffi Kar Kei Yuen, Bhaskar Somani, Vineet Gauhar","doi":"10.1097/MOU.0000000000001284","DOIUrl":"10.1097/MOU.0000000000001284","url":null,"abstract":"","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"399-411"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729182","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":"Emerging strategies: conservative management of upper tract urothelial carcinoma.","authors":"Orel Hemo, Tomer Hasdai, Hen Hendel, Asaf Shvero, Nir Kleinmann, David Lifshitz","doi":"10.1097/MOU.0000000000001290","DOIUrl":"10.1097/MOU.0000000000001290","url":null,"abstract":"<p><strong>Purpose of review: </strong>Upper tract urothelial carcinoma (UTUC) is a rare yet aggressive malignancy, representing 5-10% of urothelial cancers. While radical nephroureterectomy (RNU) has traditionally offered excellent oncological control, it compromises renal function. Recent advancements have shifted the paradigm toward kidney-sparing strategies in select cases. This review highlights innovations in UTUC diagnosis and conservative management, focusing on emerging imaging techniques, noninvasive biomarkers, and minimally invasive treatments.</p><p><strong>Recent findings: </strong>Advances in multiparametric MRI and radiomics have improved diagnostic accuracy and risk stratification. Moreover, noninvasive biomarkers - including circulating tumor DNA, microRNAs, and urinary methylation assays - provide promising tools for early detection and surveillance. Kidney-sparing approaches such as endoscopic laser ablation and segmental ureterectomy have demonstrated comparable oncologic outcomes in low-risk patients. Moreover, topical therapies, including intracavitary treatments like UGN-101, offer a promising minimally invasive option.</p><p><strong>Summary: </strong>The conservative management of UTUC is evolving, driven by advancements in imaging, molecular diagnostics, and minimally invasive treatments. While kidney-sparing approaches are increasingly utilized in low-risk patients, further prospective studies are needed to validate their efficacy.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"315-322"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989825","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":"Toxicities of taxane-based chemotherapy in prostate cancer.","authors":"Akihiro Matsukawa, Takafumi Yanagisawa, Paweł Rajwa, Takahiro Kimura","doi":"10.1097/MOU.0000000000001296","DOIUrl":"10.1097/MOU.0000000000001296","url":null,"abstract":"<p><strong>Purpose of review: </strong>Despite recent developments in the treatment of advanced prostate cancer (PCa), taxanes, including docetaxel (DOC) and cabazitaxel (CBZ), remain pivotal in management. DOC has shown efficacy for patients with metastatic hormone-sensitive prostate cancer, whereas CBZ plays a key role in the post-DOC setting. However, taxane-based therapies are associated with significant toxicities. We aimed to provide a comprehensive overview of the incidence, risk factors, and management strategies for taxane-related toxicities to optimize outcomes.</p><p><strong>Recent findings: </strong>Neutropenia and febrile neutropenia are life-threatening complications. Primary prophylactic granulocyte-colony stimulating factor (G-CSF) is recommended for CBZ. In contrast, evidence of its use with DOC is limited but should be considered for high-risk patients. Other common toxicities, such as nausea/vomiting, fatigue, neuropathy, and skin disorder, are generally nonlife-threatening but can significantly impair patients' quality of life (QoL). Tailored patient selection and individualized management strategies are essential for minimizing toxicities and ensuring treatment continuity.</p><p><strong>Summary: </strong>Despite the wide-ranging toxicities of taxanes, they remain a cornerstone in advanced PCa treatment. Preventing and managing severe neutropenia, febrile neutropenia, and QoL-impairing toxicities are essential for maintaining treatment continuity and achieving optimal outcomes.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"453-460"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062668","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":"Advancements in endourology.","authors":"Bhaskar K Somani, Dmitry Enikeev","doi":"10.1097/MOU.0000000000001285","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001285","url":null,"abstract":"","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":"35 4","pages":"313-314"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215130","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":"Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature.","authors":"Carlotta Nedbal, Pietro Tramanzoli, Daniele Castellani, Vineet Gauhar, Andrea Gregori, Bhaskar Somani","doi":"10.1097/MOU.0000000000001216","DOIUrl":"10.1097/MOU.0000000000001216","url":null,"abstract":"<p><strong>Purpose of review: </strong>To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies.</p><p><strong>Recent findings: </strong>A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: 'costs of different procedures: SWL, URS, PCNL', 'costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices', 'costs of KSD treatment in the emergency setting: emergency stenting versus primary URS'. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS.</p><p><strong>Summary: </strong>Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays' practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"368-376"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003817","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}