European urology focus最新文献

{"title":"Life Expectancy of Renal Cell Carcinoma with Variant Histology.","authors":"Quynh Chi Le, Andrea Marmiroli, Mattia Longoni, Fabian Falkenbach, Calogero Catanzaro, Michele Nicolazzini, Federico Polverino, Jordan A Goyal, Fred Saad, Riccardo Schiavina, Luca Fabio Carmignani, Alberto Briganti, Nicola Longo, Markus Graefen, Carlotta Palumbo, Mike Wenzel, Clara Humke, Marina Kosiba, Felix K-H Chun, Pierre I Karakiewicz","doi":"10.1016/j.euf.2025.05.023","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.023","url":null,"abstract":"<p><strong>Background and objective: </strong>The effect of variant histology in renal cell carcinoma (vhRCC) on survival relative to age- and sex-matched population-based controls is unknown. This study aims to analyze the life expectancy of vhRCC patients.</p><p><strong>Methods: </strong>In the Surveillance, Epidemiology and End Results (SEER) database (2004-2016), we identified 2928 patients with vhRCC, including mesenchymal, collecting duct, medullary, mucinous, and neuroendocrine RCC, as well as RCC of sarcomatoid and rhabdoid differentiation. Kaplan-Meier plots addressed overall survival relative to simulated life expectancy in population-based controls (Monte Carlo simulation), were derived from the Social Security Administration life tables.</p><p><strong>Key findings and limitations: </strong>Of the 2928 vhRCC patients, 1905 (65%) harbored sarcomatoid, 404 (14%) mesenchymal, 318 (11%) collecting duct, 94 (3%) rhabdoid, 80 (3%) medullary, 68 (2%) mucinous, and 59 (2%) neuroendocrine RCC. Most vhRCC subtypes exhibit regional or metastatic stage at diagnosis, except for mucinous RCC. When diagnosed in metastatic stage, all vhRCC subtypes exhibited a decrease in survival rate ranging from -75% to -98% between controls and cases, except for mucinous and neuroendocrine RCC, with the least decrease in survival rate of -62% and -59%, respectively. In regional stage, all vhRCC subtypes exhibited a decrease in survival rate ranging from -68% to -41% between controls and cases, except for neuroendocrine RCC, with the least decrease in survival rate of -27%. Finally, in localized stage, all vhRCC subtypes exhibited a decrease in survival rate ranging from -56% to -22% between controls and cases, except for rhabdoid and mucinous RCC, with the least decrease in survival rate of -11% and -6%, respectively.</p><p><strong>Conclusions and clinical implications: </strong>Most vhRCC subtypes reduce survival drastically relative to life expectancy of population-based controls, except for localized rhabdoid and mucinous RCC. Especially, medullary RCC leads to distinct reductions in life expectancy, irrespective of the stage at presentation.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948000","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":"Temporal Trends and Socioeconomic Determinants of Cytoreductive Nephrectomy Utilization for Metastatic Renal Cell Carcinoma in the USA.","authors":"Stepan M Esagian, Pavlos Msaouel, Jose A Karam, Benjamin A Gartrell, Dimitrios Makrakis","doi":"10.1016/j.euf.2025.05.016","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.016","url":null,"abstract":"<p><strong>Background and objective: </strong>The evolving treatment landscape in metastatic renal cell carcinoma (mRCC) since the advent of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) has rendered the role of cytoreductive nephrectomy (CN) unclear. We sought to quantify CN utilization in the USA over the past two decades and assess factors that affect access to CN.</p><p><strong>Methods: </strong>We analyzed the National Inpatient Sample database from 2006 to 2021, identifying mRCC patients who underwent CN using International Classification of Diseases (ICD)-9 and ICD-10 codes. Annual CN utilization rates were calculated and stratified by demographic and socioeconomic factors. Univariable and multivariable logistic regression analyses, guided by directed acyclic graphs, were performed to assess the factors influencing CN utilization.</p><p><strong>Key findings and limitations: </strong>CN utilization declined significantly in 2021 compared with that in 2006 (8.7% vs 15.8%; odds ratio [OR] 0.51, 95% confidence interval [CI] 0.42-0.61), a trend observed across all demographic groups. Reduced CN utilization was associated with Black (OR 0.70, 95% CI 0.64-0.76) and Hispanic (OR 0.87, 95% CI 0.80-0.95) race, female gender (OR 0.94, 95% CI 0.90-0.98), Medicare (adjusted OR [aOR] 0.69, 95% CI 0.64-0.73) or Medicaid (aOR 0.59, 95% CI 0.54-0.64) insurance, lower income (aOR 0.84, 95% CI 0.78-0.90), Southern US location (aOR 0.83, 95% CI 0.74-0.93), and treatment at small (aOR 0.57, 95% CI 0.51-0.63) or rural (aOR 0.32, 95% CI 0.26-0.38) hospitals. CN utilization declined further in the ICI (2018-2021) era compared with the TKI era (2006-2017; OR 0.69, 95% CI 0.64-0.75).</p><p><strong>Conclusions and clinical implications: </strong>CN utilization has decreased progressively in the USA, coinciding with the emergence of novel systemic therapies. Several demographic and socioeconomic factors are associated with differential CN utilization. These findings underscore the need for further research to clarify the role of CN in the evolving mRCC therapeutic landscape.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948006","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":"Exploring Management Preferences Among Patients with Small Renal Masses: Results from a Pilot Study.","authors":"Clara Diaz, Maryam Kandi, Philippe D Violette, Matthieu Gratton, Steven E Hanna, Amélie Tétu, Gordon Guyatt, Patrick O Richard","doi":"10.1016/j.euf.2025.07.008","DOIUrl":"10.1016/j.euf.2025.07.008","url":null,"abstract":"<p><strong>Background and objective: </strong>Most patients diagnosed with a small renal mass (SRM) undergo definitive treatment, but active surveillance may be offered as an alternative. Our aim was to determine patient preferences regarding management of their SRM.</p><p><strong>Methods: </strong>In this multicenter prospective pilot study, we conducted structured online interviews with patients with a new SRM diagnosis. During the interviews, patients reviewed outcome data and stated their preference for definitive treatment (thermal ablation vs partial nephrectomy). Then the patients reviewed hypothetical scenarios in a ping-pong approach and chose the maximum change in the probability of death from kidney cancer they would be willing to accept in order to decline definitive treatment.</p><p><strong>Key findings and limitations: </strong>Of the 41 participants interviewed, 71% (n = 29) preferred thermal ablation over surgery. While the median maximum increase in the probability of death from kidney cancer that patients were willing to accept to decline definitive treatment was 0.1% (interquartile range 0.1-2.5%) at 5 yr, 27% of patients reported a threshold ≥2%. Most patients (97%) preferred to review data in the form of a \"reduction in the risk of death\", rather than an \"increase in the risk of death\", or expressed no preference. Limitations include the small sample size.</p><p><strong>Conclusions and clinical implications: </strong>This pilot study demonstrates the feasibility of an innovative approach for evaluating the preferences of patients with SRMs and establishes a robust methodology for future studies. Results highlighted a strong preference for thermal ablation and for presenting data in terms of the reduction in mortality risk. Larger studies are required to validate our findings.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882420","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":"Oncologic Outcomes of Template Versus Radioguided Salvage Lymph Node Dissection for Node-only Recurrent Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography Scan: Results from a Multi-institutional Collaboration.","authors":"Carlo Andrea Bravi, Sophie Knipper, Axel Heidenreich, Nicola Fossati, Giorgio Gandaglia, Paolo Dell'Oglio, Nazareno Suardi, Daniar Osmonov, Klaus-Peter Juenemann, Jeffrey Karnes, Alexander Kretschmer, Lars Budäus, Fabian Falkenbach, Alexander Buchner, Christian Stief, Andreas Hiester, Peter Albers, Gaetan Devos, Steven Joniau, Hendrik Van Poppel, Bernhard Grubmüller, Shahrokh Shariat, David Pfister, Derya Tilki, Markus Graefen, Inderbir S Gill, Alex Mottrie, Francesco Montorsi, Alberto Briganti, Tobias Maurer","doi":"10.1016/j.euf.2025.05.019","DOIUrl":"10.1016/j.euf.2025.05.019","url":null,"abstract":"<p><p>In patients treated with salvage lymph node dissection (sLND) for nodal recurrence of prostate cancer, whether radioguided surgery (RGS) might improve oncologic outcomes as compared with template sLND remains unknown. This study included 259 patients who experienced a prostate-specific antigen (PSA) rise and nodal-only recurrence after radical prostatectomy and underwent pelvic sLND at 11 tertiary referral centers between 2012 and 2022. Lymph node recurrence was documented by prostate-specific membrane antigen positron emission tomography scans. The outcomes included biochemical recurrence (BCR) and clinical recurrence (CR) after sLND. The probability of freedom from each outcome was calculated using Kaplan-Meier analyses. A Cox regression analysis was used to test the hypothesis that surgical technique for sLND (template vs RGS) might be associated with oncologic outcomes. Overall, 80 (31%) and 179 (69%) patients received template and radioguided sLND, respectively. PSA level at sLND was higher in the template than in the radioguided group (median: 1.3 vs 0.6 ng/ml; p < 0.0001), whereas the number of positive nodes on final pathology did not differ between the groups (p = 0.13). The first postoperative PSA level was higher in the template than in the radioguided group (median: 0.5 vs 0.1 ng/ml; p < 0.0001). Overall, there were 181 cases of BCR and 76 cases of CR after sLND. The median follow-up for survivors was 21 mo (interquartile range: 7, 36). The 2-yr BCR-free survival rate for patients in the template versus RGS sLND group was 18% (95% confidence interval [CI]: 9%, 29%) versus 30% (95% CI: 22%, 37%). The 2-yr CR-free survival rate for the template versus RGS sLND group was 51% (95% CI: 35%, 65%) versus 73% (95% CI: 65%, 80%). On multivariable analyses, we did not find evidence of a statistically significant difference between the groups with respect to BCR after sLND (p = 0.7), whereas men treated with RGS had a lower risk of CR after sLND than those receiving template sLND (hazard ratio: 0.51; 95% CI: 0.29, 0.92; p < 0.026). Results of the sensitivity analyses were generally consistent with our main findings. Our data suggest that, in men with node-recurrent prostate cancer treated with sLND, RGS may offer important surgical guidance for surgeons, and this may eventually translate into improved oncologic outcomes. Awaiting further evidence on long-term outcomes of RGS, our study represents the most solid comparative data on different techniques for sLND and provides relevant data for counseling patients with node-only recurrent prostate cancer.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882421","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: Mykyta Kachanov, Alexander E. Volk, Fabian Falkenbach, et al. Evaluation of Different National Comprehensive Cancer Network Clinical Practice Guidelines in Prostate Cancer for Germline Genetic Testing in Localized and Locally Recurrent Prostate Cancer. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.05.021.","authors":"Lingyu Guo, Tian An","doi":"10.1016/j.euf.2025.07.020","DOIUrl":"10.1016/j.euf.2025.07.020","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882422","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: Alec Zhu, Mary O. Strasser, Timothy D. McClure, et al. Comparative Effectiveness of Partial Gland Cryoablation Versus Robotic Radical Prostatectomy for Cancer Control. Eur Urol Focus 2024;10:843-50.","authors":"Francesco Montorsi, Armando Stabile, Giorgio Gandaglia, Alberto Briganti","doi":"10.1016/j.euf.2025.06.022","DOIUrl":"https://doi.org/10.1016/j.euf.2025.06.022","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144845061","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":"Vibostolimab Coformulated with Pembrolizumab in Participants with Docetaxel-pretreated Metastatic Castration-resistant Prostate Cancer: KEYNOTE-365 Cohort G.","authors":"Peter C Fong, Mariusz Kwiatkowski, Alessandra Mosca, Begona P Valderrama, Chunde Li, Yi-Hsiu Huang, Ahmed H Zedan, Kamil Kuć, Pawel Wiechno, Brigitte Laguerre, Enrique Gonzalez-Billalabeitia, Mikhail Osipov, Didem Şener Dede, Jeffrey C Goh, Gedske Daugaard, Pengfei Zhu, Kentaro Imai, Yingjie Liu, José A Arranz Arija","doi":"10.1016/j.euf.2025.07.018","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.018","url":null,"abstract":"<p><p>Novel therapeutic options are needed to extend disease control and survival for patients with metastatic castration-resistant prostate cancer (mCRPC) after docetaxel. Cohort G of the phase 1b/2 KEYNOTE-365 study evaluated the efficacy and safety of vibostolimab coformulated with pembrolizumab in participants with docetaxel-pretreated mCRPC. Eligible participants with mCRPC whose disease progressed following docetaxel received vibostolimab 200 mg coformulated with pembrolizumab 200 mg intravenously every 3 wk for up to 35 cycles. Primary endpoints were the prostate-specific antigen (PSA) response rate, the objective response rate (ORR) according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 by blinded independent central review, and safety. Forty participants received the study treatment. The median follow-up was 10.2 mo (interquartile range 9.5-12.2). The confirmed PSA response rate in the overall cohort was 18% (95% confidence interval [CI] 7.3-33%). The ORR in the subgroup with RECIST-measurable disease (n = 29) was 6.9% (95% CI 0.80-23%). Treatment-related adverse events (TRAEs) occurred in 25 participants (63%); pruritus (25%), nausea (10%), and rash (7.5%) were the most common. Grade 3-5 TRAEs occurred in nine participants (23%). One treatment-related death (due to pulmonary embolism) occurred. Vibostolimab coformulated with pembrolizumab had limited antitumor activity in participants with mCRPC previously treated with docetaxel. The AE profile was manageable and consistent with the profiles of each agent. PATIENT SUMMARY: There is a need for new treatments for patients with metastatic prostate cancer that no longer responds to hormone therapy. We looked at whether a combination of two immunotherapy drugs called vibostolimab and pembrolizumab has antitumor activity with manageable side effects in a group of these patients who had already received chemotherapy. We found that this combination had limited antitumor activity, with side effects as expected for the two drugs individually. The KEYNOTE-365 trial is registered on ClinicalTrials.gov as NCT02861573.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834665","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":"Long-term Cancer Control Outcomes After Robot-assisted Radical Prostatectomy in Pathologically Non-organ-confined High-risk Prostate Cancer: 20-year Report from a Single Tertiary Referral Center.","authors":"Alessandro Bertini, Alex Stephens, Alessio Finocchiaro, Silvia Viganò, Arjun Dinesh, Elnaz Guivatchian, Antonio Perri, Giovanni Lughezzani, Nicolò Buffi, Ettore Di Trapani, Vincenzo Ficarra, Alberto Briganti, Andrea Salonia, Francesco Montorsi, Akshay Sood, Mani Menon, Craig Rogers, Firas Abdollah","doi":"10.1016/j.euf.2025.07.007","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.007","url":null,"abstract":"<p><strong>Background and objective: </strong>Exhaustive evidence on the long-term efficacy of robot-assisted laparoscopic prostatectomy (RALP) in non-organ-confined high-risk prostate cancer (PC) is still lacking. Our aim was to evaluate long-term oncological outcomes in this subset of patients treated with RALP at a single referral center.</p><p><strong>Methods: </strong>We included 803 patients with pathologically non-organ-confined high-risk PC (≥pT3a and/or pN1) at RALP between 2001 and 2022 at Henry Ford Hospital (Detroit, MI, USA). All patient underwent RALP using the Vattikuti Institute technique, with or without extended pelvic lymph node dissection (external iliac, obturator, and internal iliac nodes). The Kaplan-Meier method was used to estimate overall survival (OS) and additional treatment-free survival. The probability of PC-specific survival (PCSS) was estimated via the competing-risks method. Competing-risk and Cox regression analyses were used to identify potential predictors of PC-specific mortality (PCSM), any-cause mortality (ACM), and additional treatment.</p><p><strong>Key findings and limitations: </strong>We included 803 patients, of whom 415 (51.5%) had pT3a, 385 (47.9%) had ≥pT3b, 323 (40%) had pN1, and 670 (84%) had grade group 4-5 PC. Of the 635 patients with status information regarding additional treatment, 416 received further therapy after surgery. Specifically, 46, 110, and 260 underwent RT only, HT only, or RT + HT, respectively. Median follow-up was 72 mo (interquartile range 28-120). The 20-yr survival rates were 72.7% (95% confidence interval [CI] 56.8-86,5%) for PCSS and 45.2% (95% CI 29.1-60.1%) for OS. The rates of survival free from additional treatment were 31.3% (95% CI 26.1-36.5%) at 10 yr and 20.3% (95% CI 14.9-26.4%) at 15 yr. Multivariable regression revealed pT3b-4 stage as an independent predictor of PCSM (hazard ratio [HR] 2.50; p = 0.008), ACM (HR 1.84; p = 0.006), and additional treatment (HR 1.69; p < 0.001).</p><p><strong>Conclusions and clinical implications: </strong>For patients with non-organ-confined high-risk PC, RALP achieves long-term oncological control. This study provides the longest follow-up after RALP as the primary local treatment for patients with truly aggressive PC forms and offers valuable insights for patient counseling on long-term outcomes.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798501","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":"Infectious Complications After Transrectal Versus Transperineal Prostate Biopsy: A Systematic Review and Meta-analysis.","authors":"Fabian Peter Stangl, Elizabeth Day, Maxime Vallée, Manu P Bilsen, Nico C Grossmann, Eva Falkensammer, Ana-Maria Tapia-Herrero, Adrian Pilatz, Florian Wagenlehner, Zafer Tandogdu, Truls Erik Bjerklund Johansen, Tobias Gross, Josè Medina-Polo, Jonas Marschall, Lukas Lusuardi, Gernot Bonkat, Bela Köves, Laila Schneidewind, Jennifer Kranz","doi":"10.1016/j.euf.2025.07.005","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.005","url":null,"abstract":"<p><strong>Background and objective: </strong>Prostate biopsies remain a key step in the diagnosis of prostate cancer and are performed either via a transrectal (TR) or a transperineal (TP) route. In general, the approaches are considered to provide similar diagnostic power. However, infectious complications appear to differ in favour of the TP approach. Furthermore, antibiotic prophylaxis is felt to have limited additional value in a TP biopsy, which aligns with antimicrobial stewardship principles. Urology association guidelines have provided conflicting recommendations on the best approach for a prostate biopsy. This systematic review aims to compare the infectious complications and antibiotic usage of the two approaches.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines after registration with PROSPERO (CRD42024513309). MEDLINE, Embase, Scopus, and Web of Science were searched for articles published until April 1, 2025. Randomised controlled trials (RCTs) assessing infectious complications (fever, urinary tract infection, and hospitalisation with infectious complications) following a prostate biopsy were included. The risk of bias was assessed with the RoB 2 tool, and statistical analyses included visualisation through funnel and forest plots and assessing the publication bias via Egger's regression test.</p><p><strong>Key findings and limitations: </strong>Ten RCTs were included in the analysis, encompassing 4188 prostate biopsies. Of seven studies reporting hospitalisation for infectious complications, the TP route showed significantly lower odds (odds ratio 0.23, 95% confidence interval [CI] 0.10-0.54; graphical abstract), reducing hospitalisation risk by 77% compared with the TR route. Postinterventional fever occurred less frequently, with an odds ratio of 0.68 (95% CI 0.52-0.89). There was no statistically significant difference in infectious complications after a TP biopsy with or without antibiotics. All TR route biopsies utilised antibiotic prophylaxis. The small number of eligible studies and the high risk of bias, as well as sparse data on bias in most studies, limit the power of our manuscript.</p><p><strong>Conclusions and clinical implications: </strong>TP biopsy is associated with a lower admission risk due to postprocedural infection compared with TR biopsy. TP biopsy seems to be a safe procedure without antibiotics in patients without risk factors, advocating for enhanced antimicrobial stewardship in urology.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798579","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: Mariana Silva-Ferreira, João A. Carvalho, Sofia Salta, et al. Diagnostic Test Accuracy of Urinary DNA Methylation-based Biomarkers for Bladder Cancer: Considerations for Further Research. Eur Urol Focus 2024;10:922-34.","authors":"Hao Wang, Li Yang","doi":"10.1016/j.euf.2025.06.024","DOIUrl":"https://doi.org/10.1016/j.euf.2025.06.024","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774975","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}