European urology focus最新文献

{"title":"Impact of a Perioperative Smoking and Alcohol Cessation Intervention on Health-related Quality of Life in Patients Undergoing Radical Cystectomy: A Randomised Controlled Trial.","authors":"Susanne Vahr Lauridsen, Hanne Tønnesen, Peter Thind, Mette Rasmussen, Thomas Kallemose, Thordis Thomsen","doi":"10.1016/j.euf.2025.07.009","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.009","url":null,"abstract":"<p><strong>Background and objective: </strong>The impact of a smoking and alcohol cessation intervention on health-related quality of life (HRQoL) following radical cystectomy (RC) is unclear. This study aimed to evaluate the effect of a 6-wk perioperative smoking and/or alcohol cessation intervention on HRQoL. A secondary objective was to assess the difference in HRQoL between patients with more than two and those with fewer complications.</p><p><strong>Methods: </strong>From 2014 to 2018, 104 patients referred to RC who smoked daily or consumed at least three alcohol units per day were enrolled in a multicentre randomised clinical trial. Participants were assigned to a 6-wk intensive smoking and/or alcohol cessation programme or standard care. The smoking cessation programme had five meetings in 6 wk and was based on the principles of motivational interviewing, balanced decision-making, and the transtheoretical model of change. HRQoL was assessed at baseline, and 6 and 12 mo using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and BLM30 questionnaires. Linear regression models were used to analyse the association between intervention, complications, and HRQoL.</p><p><strong>Key findings and limitations: </strong>There were differences in baseline demographic and lifestyle factors between groups. At the end of intervention, 51% of the intervention group and 27% of the control group quit successfully; after 12 mo, 21% and 36%, respectively, were quitters. No significant differences in HRQoL were found between the intervention and control groups. However, patients with more than two complications had significantly lower HRQoL on the QLQ-C30 scale, while no difference was observed on the BLM30 scale. A study limitation is the nonparticipation rate of 53%.</p><p><strong>Conclusions and clinical implications: </strong>The cessation intervention did not impact HRQoL significantly in patients undergoing RC. However, patients with more than two complications experienced reduced HRQoL, highlighting the importance of identifying at-risk patients preoperatively.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of the Stockholm3 Test in Guiding Confirmation Biopsy Decisions for Patients with Prostate Cancer on Active Surveillance.","authors":"Serdar Madendere, Mert Kılıç, Erhan Palaoğlu, Mert Veznikli, Metin Vural, Ayşenur İğdem, Derya Tilki, Tarık Esen, Derya Balbay","doi":"10.1016/j.euf.2025.06.016","DOIUrl":"https://doi.org/10.1016/j.euf.2025.06.016","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aim of our study was to assess correlation between Stockholm3 test results, multiparametric magnetic resonance imaging (mpMRI) findings, and confirmation biopsy outcomes in a cohort of patients on active surveillance (AS) for prostate cancer (PC).</p><p><strong>Methods: </strong>The study cohort comprised 26 patients on AS for International Society of Urological Pathology grade group (GG) 1 PC. Repeat MRI and confirmation biopsy following a Stockholm3 test were performed for all. We defined a Stockholm3 score cutoff of ≥15 for higher risk of clinically significant PC (csPC). The sensitivity and negative predictive value (NPV) of the Stockholm3 test and mpMRI for prediction of csPC were assessed.</p><p><strong>Key findings and limitations: </strong>The median age for the study cohort was 63 yr. Median PSA was 4.6 ng/ml and the median Stockholm3 score was 17. Sixteen patients (61.5%) had lesion with a Prostate Imaging-Reporting and Data System (PI-RADS) score of ≥4 on repeat mpMRI. Confirmatory biopsy revealed benign histology in five patients (19.3%), GG 1 PC in 13 patients (50%), and GG >1 PC (upgrading) in eight patients (30.7%). Using a score cutoff of ≥15 for the Stockholm3 test yielded sensitivity of 87.5% and an NPV of 90% for upgrading on confirmatory biopsy. Of 16 patients with a PI-RADS ≥4 lesion on MRI, 43.7% had csPC on confirmatory biopsy. PI-RADS ≥4 had sensitivity of 87.5% and an NPV of 90% for prediction of csPC.</p><p><strong>Conclusions and clinical implications: </strong>For most of our 26 patients on AS with a Stockholm3 score of <15, confirmatory biopsy revealed GG 1 and benign histology. A confirmatory biopsy should be recommended for all patients with PI-RADS ≥4 lesions irrespective of their Stockholm3 score, but could be avoided in cases with negative MRI findings and a Stockholm3 score of <15.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 Density as a Selection Tool Before Magnetic Resonance Imaging in Prostate Cancer Screening: An Analysis from the STHLM3MRI Randomized Clinical Trial.","authors":"Lars Björnebo, Andrea Discacciati, Ahmad Abbadi, Ugo Giovanni Falagario, Jan Chandra Engel, Hari T Vigneswaran, Fredrik Jäderling, Henrik Grönberg, Martin Eklund, Anna Lantz, Tobias Nordström","doi":"10.1016/j.euf.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.euf.2025.06.008","url":null,"abstract":"<p><strong>Background and objective: </strong>Prostate cancer screening is challenged by overdetection, overtreatment, and high resource use. Prostate-specific antigen (PSA) density (PSAD) correlates more strongly with clinically significant cancer than PSA alone. We compare outcomes using various PSAD cutoffs to select men for magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>STHLM3MRI is a screening-by-invitation trial with 49 118 men invited and 12 750 screened. In the experimental arm, participants with elevated PSA (≥3 ng/ml) had MRI and, if positive [PI-RADS] score ≥3), systematic and targeted biopsies. Evaluated PSAD cutoffs were 0.075, 0.10, 0.125, and 0.15 ng/ml². Prostate volume was measured by MRI or transrectal ultrasound. The primary endpoint was Gleason ≥3 + 4 cancer detection. The secondary endpoints were Gleason 6 and ≥4 + 3 cancer detection, and the number of MRI scans and biopsies. Relative positive fractions (RPFs) compared the outcomes using PSA ≥3 ng/ml alone.</p><p><strong>Key findings and limitations: </strong>Of 7609 men in the experimental arm, 929 (12.2%) had PSA ≥3 ng/ml, and 846 (91%) underwent MRI, with 38% having a PI-RADS score of ≥3. The median prostate volume was 45 ml (interquartile range [IQR], 33-62 ml) and PSAD 0.10 ng/ml² (IQR, 0.07-0.14 ng/ml²). A PSAD cutoff of 0.075 ng/ml² reduced Gleason 6 cancer detection by 17% (RPF, 0.83; 95% confidence interval [CI], 0.72-0.96), lowered MRI use by 28% (RPF, 0.72; 95% CI, 0.69-0.75), and missed 5% (RPF, 0.95; 95% CI, 0.92-0.98) of Gleason ≥3 + 4 cancer cases, with no difference in Gleason ≥4 + 3 cancer detection. Higher PSAD thresholds reduced Gleason 6 cancer detection and MRI use, but lowered Gleason ≥3 + 4 cancer detection. Limitations include assumed equivalency between MRI and ultrasound volume.</p><p><strong>Conclusions and clinical implications: </strong>The use of PSAD before MRI lowers overdiagnosis and resource use, while maintaining detection of significant cancer cases. Our results suggest that a PSAD cutoff above 0.075 ng/ml² is not advisable, regardless of age, due to the increased risk of missing cancer cases with Gleason scores ≥3 + 4.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune-based Combinations in Intermediate-/Poor-risk Patients with Non-clear Cell Renal Cell Carcinoma: Results from the ARON-1 Study.","authors":"Francesco Massari, Veronica Mollica, Ray Manneh Kopp, Enrique Grande, Ondřej Fiala, Ravindran Kanesvaran, Haoran Li, Timothy J Schieber, Maria José Juan Fita, Alexandr Poprach, Cristian Lolli, Maria T Bourlon, Alfonso Gómez de Liaño, Francesco Grillone, Kaisa Sunela, Alessandro Rizzo, Marwan Ghosn, Linda Cerbone, Tarek Taha, Yüksel Ürün, Javier Molina-Cerrillo, Teresa Alonso-Gordoa, Edoardo Lenci, Inmaculada Orejana Martin, Hussam Abu-Sini, Pasquale Rescigno, Dipen Bhuva, Andre Poisl Fay, Vincenza Conteduca, Ahmet Yildirim, Matteo Rosellini, Umut Akova, Elisa Tassinari, Hatice Bölek, Andrey Soares, Fernando Sabino Marques Monteiro, Sebastiano Buti, Mehmet Asim Bilen, Matteo Santoni","doi":"10.1016/j.euf.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.020","url":null,"abstract":"<p><strong>Background and objective: </strong>Non-clear cell renal cell carcinoma (nccRCC) lacks direct comparisons of immune-based combinations, presenting an unmet need for defining optimal treatment for this specific population. This study aimed to assess the real-world efficacy of immune-based combinations in intermediate-/poor-risk nccRCC.</p><p><strong>Methods: </strong>We conducted a multicenter, retrospective study of patients (≥18 yr) with metastatic nccRCC treated with first-line immune-based combinations across 56 centers in 17 countries between January 2021 and December 2024. Patients received pembrolizumab/lenvatinib, pembrolizumab/axitinib, nivolumab/cabozantinib, or nivolumab/ipilimumab. The primary endpoints were overall survival (OS) and progression-free survival (PFS), analyzed using Kaplan-Meier and Cox proportional-hazard models, and overall response rate (ORR) evaluated as per RECIST 1.1 criteria.</p><p><strong>Key findings and limitations: </strong>Among the 323 patients analyzed (median follow-up: 21.2 mo), the median OS was 31.1 mo (95% confidence interval [CI] 24.6-40.4), with a 2-yr OS rate of 58%. The ORR was 38% (2% complete response and 36% partial response), and the median PFS was 13.0 mo (95% CI 10.0-17.4). Immune checkpoint inhibitors (ICIs) plus tyrosine kinase inhibitors (TKIs) significantly outperformed ICI doublets across efficacy metrics. Limitations include retrospective design and a selection bias.</p><p><strong>Conclusions and clinical implications: </strong>Our analysis suggests ICI/TKI combinations as the optimal strategy for intermediate-/poor-risk nccRCC, with pembrolizumab/lenvatinib showing marked benefits. Further studies are needed to validate these findings.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Trial Protocol for prePSMA: A Multicenter, Randomized, Noninferiority Trial of Preoperative Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography as Triage for Extended Pelvic Lymph Node Dissection in Patients Scheduled for Robot-assisted Laparoscopic Radical Prostatectomy.","authors":"Lars F Qvigstad, Kirsti Aas, Andreas Tulipan, Knut H Hole, Anne H Storås, Clara Hammarström, Reza Ghiasvand, Stein H Holmedal, Viktor Berge","doi":"10.1016/j.euf.2025.07.010","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.010","url":null,"abstract":"<p><p>prePSMA is a randomized controlled trial in which patients with high-risk prostate cancer and selected cases with intermediate-risk disease are randomized to a control arm in which all patients undergo extended pelvic lymph node dissection (ePLND), or an experimental arm in which ePLND is only performed in patients with positive preoperative findings on prostate-specific membrane antigen positron emission tomography/computed tomography.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future of Novel Antibody-drug Conjugates in Localized Urothelial Cancer.","authors":"Mikolaj Filon, Bogdana Schmidt","doi":"10.1016/j.euf.2025.07.016","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.016","url":null,"abstract":"<p><p>Antibody-drug conjugates (ADCs) have recently transformed the paradigm for metastatic urothelial carcinoma treatment. As these therapies demonstrate increasing efficacy and tolerability, attention is turning toward their use in earlier stages of disease. The current molecular targets for ADCs featured in large-scale trials have been Nectin-4 and TROP-2, leading to the development of enfortumab vedotin and sacituzumab govitecan; however, additional promising targets under investigation include HER2, FGFR3, EGFR, and CD-44. While identification of these targets is exciting, the next challenge is harnessing delivery mechanisms to maximize local responses, while limiting systemic toxicity. ADCs have the potential to enhance our ability to offer bladder-sparing therapies to patients with refractory non-muscle-invasive and potentially muscle-invasive disease, who were previously relying on radical cystectomy for treatment. ADCs represent an emerging frontier in the therapeutic landscape of urothelial carcinoma. While their use has thus far been limited to advanced disease, ongoing clinical trials and emerging data suggest possible expanded applications for ADCs in localized bladder cancer. PATIENT SUMMARY: A new standard has emerged for metastatic urothelial carcinoma treatment with the combination of immunotherapy and antibody-drug conjugates. The use of these agents has the potential to transform the space of localized bladder cancer. While promising, many questions remain unanswered about how these new agents will be integrated into the treatment paradigm of non-muscle-invasive and localized muscle-invasive disease.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Salvador Arlandis. Management of Stress Urinary Incontinence in Patients with Underactive Bladder. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.04.030.","authors":"Jean-Nicolas Cornu","doi":"10.1016/j.euf.2025.06.023","DOIUrl":"https://doi.org/10.1016/j.euf.2025.06.023","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urothelial Cancer: Leveraging Circulating Tumor DNA To Avoid Unnecessary Bladder-directed and Systemic Therapies.","authors":"Jonathan Chatzkel, Joshua Linscott, G Daniel Grass, Roger Li","doi":"10.1016/j.euf.2025.07.012","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.012","url":null,"abstract":"<p><p>Several studies have demonstrated the potential of circulating tumor DNA (ctDNA) for personalization of perioperative systemic treatment in muscle-invasive urothelial carcinoma (UC). Early studies focused on the ability to identify patients with residual disease who may benefit from additional systemic treatment. Further studies have suggested the potential of ctDNA measurement to tailor systemic and local treatments for patients with MIUC. This biomarker may ultimately reduce overtreatment, toxicity, and the financial burden associated with UC care. As ctDNA testing matures, it may offer clinicians a means to truly personalize treatment and thereby improve oncologic outcomes and enhance patients' quality of life. PATIENT SUMMARY: Our mini review looks at studies in which DNA from bladder cancer tumors that is circulating in the blood (called circulating tumor DNA, or ctDNA) is measured. Measurement of ctDNA levels after chemotherapy or immunotherapy can help predict cancer outcomes in patients undergoing bladder removal surgery.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incisional Hernia After Transperitoneal Robot-assisted Radical Prostatectomy: A Call for Greater Awareness Among Urologists.","authors":"Arthur Peyrottes, Charles Dariane, Alexandre Colau, Maxime Pattou, Andrei Necsulescu, Arnaud Méjean, François Desgrandchamps, Olivier Oberlin, Guillaume Ploussard, Alexandra Masson-Lecomte","doi":"10.1016/j.euf.2025.07.015","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.015","url":null,"abstract":"<p><p>Incisional hernia (IH) is a clinically relevant yet under-reported complication of transperitoneal robot-assisted radical prostatectomy (RARP). As this approach becomes standard, identification of procedure-specific risk factors to inform prevention strategies is essential to improve surgical outcomes for prostate cancer. We conducted an analysis of patients with localised prostate cancer who underwent transperitoneal RARP with supraumbilical specimen extraction between 2020 and 2024 in three academic centres in France. The primary endpoint was IH prevalence at 1 yr. Independent predictors were identified via multivariable analysis. A total of 629 patients were included. Median age was 61 yr (interquartile range [IQR] 66-70), and median prostate-specific antigen was 6.16 ng/ml (IQR 8.18-12). According to the D'Amico classification, 8% of patients had low risk, 75% had intermediate risk, and 17% had high risk. At 1-yr follow-up, 76 patients (12.1%) had developed IH at the supraumbilical extraction site, of whom 53 (70%) underwent surgical repair. Multivariable analysis identified higher body mass index, smoking, and postoperative parietal abscess as independent risk factors for IH. IH is a relatively frequent yet often overlooked complication of RARP. The IH incidence in our study suggests underdiagnosis of this complication, with potential consequences that include bowel obstruction and chronic pain. Optimisation of fascial closure and reconsideration of the extraction site location might reduce IH risk. Systematic imaging for high-risk patients could improve early detection. PATIENT SUMMARY: We looked at the risk of developing a hernia in the abdomen wall after robotic surgery for prostate cancer. We found that these hernias are more common than previously thought, especially in patients with obesity, smoking habits, or wound infections. A careful surgical technique and closer follow-up may help in reducing the risk of this complication and improve outcomes.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Jean-Nicolas Cornu's Letter to the Editor re: Salvador Arlandis. Management of Stress Urinary Incontinence in Patients with Underactive Bladder. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.04.030.","authors":"Salvador Arlandis","doi":"10.1016/j.euf.2025.07.013","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.013","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}