European urology focus最新文献

{"title":"Determining Optimal Patient Selection for High-intensity Focused Ultrasound for Prostate Cancer.","authors":"Kevin Shee, William A Pace, Andrew W Liu, Janet E Cowan, Vishvak Subramanyam, Cameron Agapito, Samuel L Washington, Matthew R Cooperberg, Peter R Carroll, Katsuto Shinohara, Hao G Nguyen","doi":"10.1016/j.euf.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.euf.2025.06.007","url":null,"abstract":"<p><strong>Background and objective: </strong>Magnetic resonance imaging (MRI)/ultrasound-guided high-intensity focused ultrasound (HIFU) ablates prostate cancer with promising cancer control and minimal impact on sexual or urinary function. However, recurrence remains a concern. This study identifies factors associated with recurrence and treatment failure to optimize patient selection.</p><p><strong>Methods: </strong>Men who underwent robotic HIFU (FocalOne) at University of California San Francisco (2021-2023) and had a 1-yr post-HIFU MRI-fusion biopsy were included. The primary outcomes were biopsy-proven in-field and overall recurrence. The secondary outcomes included treatment failure (salvage whole-gland treatment with surgery or radiation, or development of metastases) and changes in urinary/sexual function. Cox proportional hazards and multivariable logistic regression were used for an analysis.</p><p><strong>Key findings and limitations: </strong>Among 135 men with a follow-up biopsy at 12 mo, pre-HIFU Gleason grade ≥3 (≥GG3; hazard ratio [HR] 3.11; 95% confidence interval [CI] 1.30-7.47) and a high genomic risk score (HR 2.87; 95% CI 1.18-6.99) were associated with in-field biopsy-proven recurrence. Overall biopsy-proven recurrence was linked to ≥GG3 (HR 2.62; 95% CI 1.03-6.67) and prostate-specific antigen (PSA) >10 versus <6 ng/ml (HR 5.64; 95% CI 1.82-17.48). The rates of treatment failure requiring salvage whole-gland treatment or metastasis was 4% at 1 yr and 16% overall, with a median (interquartile range) time to treatment failure of 16 (13-18) mo. Urinary and sexual function remained unchanged; no Clavien-Dindo grade >2 complications, urethral stricture, or urethra-rectal fistula were recorded.</p><p><strong>Conclusions and clinical implications: </strong>Pre-HIFU ≥GG3 disease, a high genomic risk score, and elevated PSA correlate with local recurrence. These findings emphasize the importance of careful patient selection, as HIFU can effectively control cancer with minimal urinary or sexual side effects in suitable patients.</p>","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":"144774974","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":"Estimating the Carbon Emissions of a Single Prostate-specific Antigen Test: Results from a Cradle-to-grave Life Cycle Assessment.","authors":"Hanna Zurl, Stephan M Korn, Klara K Pohl, Zhiyu Qian, Andrea Piccolini, Hari S Iyer, Michael S Leapman, Sascha Ahyai, Shahrokh F Shariat, Quoc-Dien Trinh, Cassandra L Thiel, Stacy Loeb, Alexander P Cole","doi":"10.1016/j.euf.2025.07.006","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.006","url":null,"abstract":"<p><strong>Background and objective: </strong>The health care sector is a significant contributor to greenhouse gas (GHG) emissions, and assessments of the environmental impacts of health services are essential. We aimed to evaluate the environmental impact of a highly common but controversial urology-specific blood test: the prostate-specific antigen (PSA) test.</p><p><strong>Methods: </strong>A cradle-to-grave life cycle assessment was performed to estimate the emissions of a single PSA test. Primary data collection included laboratory site assessment, disassembly, and weighing of materials. The primary outcome was GHG emissions in grams of carbon dioxide equivalent (CO₂e). The secondary outcome was the health impact attributed to the environmental harm of the test.</p><p><strong>Key findings and limitations: </strong>A single PSA test generates an estimated total of 189.7 g of CO₂e. The majority of emissions (88.2%) were generated by the raw materials, manufacturing, production, and disposal of the blood draw equipment. Annual CO₂e emissions from PSA testing in the USA were estimated at 5 691 000 kg CO₂e, equivalent to driving 14.5 million miles, with a resulting human health impact of 6.6 disability-adjusted life years annually. This study focused on the PSA test itself, and not on emissions from staff, patient, or sample transportation; building infrastructure; or cleaning.</p><p><strong>Conclusions and clinical implications: </strong>Although the carbon footprint of a single PSA test is small, the cumulative impact of the estimated total of 30 million PSA tests performed annually in the USA is substantial, especially when considering that a notable proportion of these tests may be performed on men who are unlikely to benefit.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768567","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":"Review of Transperineal and Transrectal Prostate Biopsy Outcomes.","authors":"Evan Suzman, B Malik Wahba, Gal Wald, Aayush Kaneria, Jim C Hu","doi":"10.1016/j.euf.2025.07.017","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.017","url":null,"abstract":"<p><p>More than 2 million prostate biopsies are performed annually in the USA and Europe, but there is debate over the optimal approach. The procedural time is shorter for transrectal (TR) than for transperineal (TP) biopsy, but prospective randomized trials have demonstrated that TR biopsy has a greater risk of infectious complications and inferior cancer detection rates. As a result, professional guideline recommendations are shifting in favor of TP biopsy. Nevertheless, the TR approach still accounts for the majority of biopsies performed worldwide. Barriers to TP biopsy adoption include limited training opportunities, longer procedure duration, and higher costs in comparison to TR biopsy. PATIENT SUMMARY: A prostate biopsy is carried out for patients who have a suspicion for prostate cancer, but there is debate over the best biopsy approach. Transrectal (TR) biopsy takes less time than transperineal (TP) biopsy. Trials have shown that TR biopsy has a higher risk of infectious complications and a similar cancer detection rate. Guidelines are therefore shifting in favor of TP biopsy, although limited training opportunities, the longer procedure time, and higher costs are barriers to more widespread use of this approach.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768568","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":"Shaping the Future of Personalized Therapy in Bladder Cancer Using Artificial Intelligence.","authors":"Martina Maggi, Francesco Chierigo, Giuseppe Fallara, Letizia Maria Ippolita Jannello, Marco Tozzi, Francesco Pellegrino, Felice Crocetto, Daniela Terracciano, Roberto Bianchi, Matteo Ferro","doi":"10.1016/j.euf.2025.07.011","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.011","url":null,"abstract":"<p><p>Bladder cancer (BC) ranks among the tenth most common cancers globally, and its management remains a significant challenge for both patients and clinicians in terms of care delivery and decision-making process. The integration of artificial intelligence (AI) tools-primarily machine learning and deep learning methods-into the current BC workflow offers an opportunity for a more personalized approach to treatment. This article provides a brief overview of AI applications across different steps of BC management (ie, detection, grading, staging, risk stratification, treatment, and outcome prediction), highlighting its potential to contribute to individualized management strategies. Despite significant advances, major barriers still impede broad applications of AI in BC clinical workflows. Overcoming these obstacles is critical to realize the full potential of AI-driven personalization of BC care in the coming decade. PATIENT SUMMARY: Our mini review summarizes how artificial intelligence (ie, a machine's ability to mimic human intelligence to perform tasks involving decision-making and problem-solving) has been applied to the management of bladder cancer, and whether it could lead to more precise treatment for patients diagnosed with this disease. Although several promising applications have been developed, more studies are necessary before these can be used in routine clinical practice.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768569","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":"Urinary Tumor DNA-based Liquid Biopsy in Bladder Cancer Management: A Systematic Review.","authors":"Joanne Lee, Fei Chen, Antonio Lopez-Beltran, Andrea Necchi, Alessia Cimadamore, Philippe E Spiess, Roger Li, Sinchita Roy-Chowdhuri, Rodolfo Montironi, Dragan Golijanin, Claudio Luchini, Liang Cheng","doi":"10.1016/j.euf.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.euf.2025.06.009","url":null,"abstract":"<p><strong>Background and objective: </strong>Urinary tumor DNA (utDNA) has emerged as a promising biomarker in the care, diagnosis, early detection, recurrence monitoring, and prognosis of bladder cancer (BCa). Its noninvasive nature, ease of access, and cost effectiveness make it an attractive option for both patients and health care providers. This review describes the current state of utDNA as a marker of BCa.</p><p><strong>Methods: </strong>Articles published between 2015 and 2025 on current utDNA-based techniques in BCa were identified and analyzed for relevance and insight into utDNA research and usage.</p><p><strong>Key findings and limitations: </strong>Recent investigations underscore the noninvasiveness and superior tumor detection capabilities of utDNA, particularly in the detection of minimal residual disease. Moreover, utDNA provides actionable information, such as tumor grade and staging information, to support precise treatment decisions, including targeted immunotherapy regimens and bladder preservation strategies. Although utDNA has shown promising results in small studies, larger studies must be performed before it can be considered as a standard procedure in clinical practice.</p><p><strong>Conclusions and clinical implications: </strong>Urinary tumor DNA has demonstrated great potential to improve on most, if not all, stages of detection, treatment, and monitoring of BCa. By preserving the low cost and noninvasiveness of urine cytology, and by replacing its suboptimal accuracy with a precision rivaling and often exceeding cystoscopy and circulating tumor DNA-based methods, utDNA offers patients a more comfortable, repeatable, and accurate way of detecting BCa. With increased sensitivity and accuracy, everything from low-grade tumors to the earliest signs of recurrence can be detected more effectively, optimizing patient treatment courses and improving outcomes.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768570","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":"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}