European urology最新文献

{"title":"What’s in a Name? Why Words Matter in Advanced Prostate Cancer","authors":"William K. Oh, Neeraj Agarwal, Alan Bryce, Pedro Barata, Courtney Bugler, Sigrid V. Carlsson, Brad Cornell, William Dahut, Daniel George, Stacy Loeb, Bruce Montgomery, David Morris, Lorelei A. Mucci, Aurelius Omlin, Ganesh Palapattu, Irbaz Bin Riaz, Charles Ryan, Martin W. Schoen, Samuel L. Washington, Silke Gillessen","doi":"10.1016/j.eururo.2024.10.017","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.10.017","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Metastatic hormone-sensitive prostate cancer (mHSPC)</h2>The debate concerning the scientific accuracy and negative connotations of the word “castration” for patients has been discussed previously [3], [4] and is clearly a prominent example of the powers—positive and negative—mentioned above. In particular, we believe that the word “castration” is difficult for patients, partners, and families to hear and should be avoided when we describe this advanced prostate cancer disease state. mHSPC is the most common term for patients with newly diagnosed</section></section><section><section><h2>Androgen deprivation–resistant prostate cancer (ARPC)</h2>One widely used term is “castration-resistant” prostate cancer. Since all patients with this disease state are resistant to androgen deprivation, we propose a new term: androgen deprivation–resistant prostate cancer (ARPC).</section></section><section><section><h2>Androgen receptor pathway inhibitors (ARPI)</h2>The class of androgen receptor (AR) pathway inhibitors (eg, abiraterone acetate, apalutamide, darolutamide, enzalutamide) appears to have many names, going back decades to the first “anti-androgens” such as bicalutamide. Currently, various terms such as AR signaling inhibitors (ARSI), novel hormonal therapies (NHT), AR-targeted agents (ARTA), and second- or next-generation hormonal therapies are all used. Unfortunately, this nomenclature is not only confusing but is also prone to becoming</section></section><section><section><h2>Combination therapy for mHSPC (ADT plus ARPI +/- docetaxel)</h2>Multiple randomized trials have demonstrated superior overall survival in mHSPC with the addition of an ARPI to ADT (“doublet therapy”) or an ARPI to ADT and docetaxel chemotherapy (“triplet therapy”) [6], [7]. Describing regimens comprising two or three drugs as doublets or triplets may be descriptive but can easily be misinterpreted. For instance, the term “triplet therapy” in mHSPC has been used to describe ADT + ARPI + radiation therapy to the prostate by some investigators. Future</section></section>","PeriodicalId":12223,"journal":{"name":"European urology","volume":null,"pages":null},"PeriodicalIF":23.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and Considerations in Modern Adjuvant Therapy Trials in Renal Cell Carcinoma: A Call to Power","authors":"Daniel D. Shapiro, Pavlos Msaouel","doi":"10.1016/j.eururo.2024.10.020","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.10.020","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":null,"pages":null},"PeriodicalIF":23.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142519985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Natural History of Histologically Benign PIRADS 4–5 Lesions in Multiparametric MRI: Real-life Experience in an Academic Center","authors":"Vincenzo Ficarra, Gabriele Sorce, Marta Rossanese, Ettore Di Trapani","doi":"10.1016/j.eururo.2024.09.027","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.09.027","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":null,"pages":null},"PeriodicalIF":23.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Roger L. Sur’s Letter to the Editor re: Frédéric Panthier, Vineet Gauhar, Eugenio Ventimiglia, Jia-Lun Kwok, Etienne Xavier Keller, Olivier Traxer. Rethinking Stone-free Rates and Surgical Outcomes in Endourology: A Point of View from PEARLS Members. Eur Urol 2024;86:198–9","authors":"Frédéric Panthier, Bhaskar Somani, Olivier Traxer","doi":"10.1016/j.eururo.2024.10.015","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.10.015","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":null,"pages":null},"PeriodicalIF":23.4,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Biparametric Versus Multiparametric Magnetic Resonance Imaging for Diagnosing Clinically Significant Prostate Cancer: An International, Paired, Noninferiority, Confirmatory Observer Study","authors":"Jasper J. Twilt, Anindo Saha, Joeran S. Bosma, Bram van Ginneken, Anders Bjartell, Anwar R. Padhani, David Bonekamp, Geert Villeirs, Georg Salomon, Gianluca Giannarini, Jayashree Kalpathy-Cramer, Jelle Barentsz, Klaus H. Maier-Hein, Mirabela Rusu, Olivier Rouvière, Roderick van den Bergh, Valeria Panebianco, Veeru Kasivisvanathan, Nancy A. Obuchowski, Derya Yakar, Maarten de Rooij","doi":"10.1016/j.eururo.2024.09.035","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.09.035","url":null,"abstract":"<h3>Background and objective</h3>Biparametric magnetic resonance imaging (bpMRI), excluding dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), is a potential replacement for multiparametric MRI (mpMRI) in diagnosing clinically significant prostate cancer (csPCa). An extensive international multireader multicase observer study was conducted to assess the noninferiority of bpMRI to mpMRI in csPCa diagnosis.<h3>Methods</h3>An observer study was conducted with 400 mpMRI examinations from four European centers, excluding examinations with prior prostate treatment or csPCa (Gleason grade [GG] ≥2) findings. Readers assessed bpMRI and mpMRI sequentially, assigning lesion-specific Prostate Imaging Reporting and Data System (PI-RADS) scores (3–5) and a patient-level suspicion score (0–100). The noninferiority of patient-level bpMRI versus mpMRI csPCa diagnosis was evaluated using the area under the receiver operating curve (AUROC) alongside the sensitivity and specificity at PI-RADS ≥3 with a 5% margin. The secondary outcomes included insignificant prostate cancer (GG1) diagnosis, diagnostic evaluations at alternative risk thresholds, decision curve analyses (DCAs), and subgroup analyses considering reader expertise. Histopathology and ≥3 yr of follow-up were used for the reference standard.<h3>Key findings and limitations</h3>Sixty-two readers (45 centers and 20 countries) participated. The prevalence of csPCa was 33% (133/400); bpMRI and mpMRI showed similar AUROC values of 0.853 (95% confidence interval [CI], 0.819–0.887) and 0.859 (95% CI, 0.826–0.893), respectively, with a noninferior difference of –0.6% (95% CI, –1.2% to 0.1%, <em>p</em> &lt; 0.001). At PI-RADS ≥3, bpMRI and mpMRI had sensitivities of 88.6% (95% CI, 84.8–92.3%) and 89.4% (95% CI, 85.8–93.1%), respectively, with a noninferior difference of –0.9% (95% CI, –1.7% to 0.0%, <em>p</em> &lt; 0.001), and specificities of 58.6% (95% CI, 52.3–63.1%) and 57.7% (95% CI, 52.3–63.1%), respectively, with a noninferior difference of 0.9% (95% CI, 0.0–1.8%, <em>p</em> &lt; 0.001). At alternative risk thresholds, mpMRI increased sensitivity at the expense of reduced specificity. DCA demonstrated the highest net benefit for an mpMRI pathway in cancer-averse scenarios, whereas a bpMRI pathway showed greater benefit for biopsy-averse scenarios. A subgroup analysis indicated limited additional benefit of DCE MRI for nonexperts. Limitations included that biopsies were conducted based on mpMRI imaging, and reading was performed in a sequential order.<h3>Conclusions and clinical implications</h3>It has been found that bpMRI is noninferior to mpMRI in csPCa diagnosis at AUROC, along with the sensitivity and specificity at PI-RADS ≥3, showing its value in individuals without prior csPCa findings and prostate treatment. Additional randomized prospective studies are required to investigate the generalizability of outcomes.","PeriodicalId":12223,"journal":{"name":"European urology","volume":null,"pages":null},"PeriodicalIF":23.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: [89Zr]Zr-Girentuximab for PET–CT Imaging of Clear-cell Renal Cell Carcinoma: A Prospective, Open-label, Multicentre, Phase 3 Trial","authors":"Riccardo Campi, Alessio Pecoraro, Salvatore Granata, Sergio Serni","doi":"10.1016/j.eururo.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.10.013","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":null,"pages":null},"PeriodicalIF":23.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensitive Detection of Urothelial Cancer via High-volume Urine DNA Analysis","authors":"Jussi Nikkola, Lauri Ryyppö, Juuso Vuorinen, Heini Kallio, Hanna Selin, Pyry Jämsä, Jonne Åkerla, Tuomo Virtanen, Tarmo Pekkarinen, Antti Kaipia, Johanna Pulkkinen, Gillian Vandekerkhove, David C. Müller, Alexander W. Wyatt, Peter C. Black, Matti Nykter, Thea Veitonmäki, Matti Annala","doi":"10.1016/j.eururo.2024.10.014","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.10.014","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":null,"pages":null},"PeriodicalIF":23.4,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Ex Vivo Surgical Removal Versus Conservative Management of Small Asymptomatic Kidney Stones in Living Donors and Long Term Kidney Transplant Outcomes","authors":"Emilien Seizilles de Mazancourt, Paul Meria","doi":"10.1016/j.eururo.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.10.011","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":null,"pages":null},"PeriodicalIF":23.4,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142450257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Radiopharmaceuticals and Future of Theranostics in Genitourinary Cancers","authors":"Martina Sollini, Jeremie Calais, Arturo Chiti, Louise Emmett, Stefano Fanti, Wolfgang Fendler, Ken Herrmann, Thomas A. Hope, Oliver Sartor, Brian Shuch, Scott Tagawa, Michael S. Hofman","doi":"10.1016/j.eururo.2024.09.036","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.09.036","url":null,"abstract":"<h3>Background and objective</h3>This review aims to provide an overview of novel diagnostic and therapeutic radiopharmaceuticals tested recently or used currently in genitourinary cancers within prospective phase 1–2 clinical trials, summarizing progresses and future directions.<h3>Methods</h3>A systematic search was conducted using the PubMed/MEDLINE and ClinicalTrials.gov databases for original prospective research studies following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.<h3>Key findings and limitations</h3>Forty-six papers were systematically reviewed; 74 ongoing clinical trials were identified. The results of 27 novel radiopharmaceuticals (ie, not approved by the Food and Drug Administration/European Medicines Agency and not listed in the Pharmacopeia) prospectively investigated in genitourinary cancers, mostly prostate, for diagnostic, theranostic, or therapeutic purposes (21, one, and five of the 27 radiopharmaceuticals, respectively) over the past 5 yr were presented. Most were prostate-specific membrane antigen–targeting agents (17/27); other targets included gastrin-releasing peptide receptor, carbonic anhydrase IX, Cu, six transmembrane epithelial antigen of the prostate 1, tumor-associated glycoprotein 42, and urokinase-type plasminogen activator receptor. Ongoing research confirms the same trend. Fibroblast activation protein inhibitor, PD-L1, CD8, nectin-4, and HER2 are other targets under investigation. Among the 22 ongoing therapeutic trials (out of the 74 ongoing clinical trials), targeted alpha therapy is being explored in 12, and five are evaluating combinations of radioligand therapy with other treatments. We confirmed the safety of radiopharmaceuticals (regardless of the diagnostic/therapeutic purpose) and showed promising results in terms of diagnostic accuracy and therapeutic efficacy in genitourinary cancers.<h3>Conclusions and clinical implications</h3>There continues to be expansion in radiopharmaceutical approaches to genitourinary cancers, reflecting a strong emphasis on improving tumor detection and treatment, which will likely impact future management across the disease spectrum, with the potential for improved patient care and outcomes.","PeriodicalId":12223,"journal":{"name":"European urology","volume":null,"pages":null},"PeriodicalIF":23.4,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142450251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management Decisions for Metastatic Castration-resistant Prostate Cancer in 2024","authors":"David J. VanderWeele, Maha Hussain","doi":"10.1016/j.eururo.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.10.003","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>One size does not fit all: the importance of biomarkers</h2>One of the themes from the review by Francini et al [1] that should be highlighted is the importance of biomarkers. Several new therapies are approved for biomarker-selected patients. When the right biomarker is present, patients have a better chance of deriving greater benefit from biomarker-directed therapy. In PROPEL, the hazard ratio (HR) for OS with addition of olaparib versus abiraterone alone for patients with a <em>BRCA1</em> or <em>BRCA2</em> alteration was 0.29 [2]. Many patients with tumors with high</section></section><section><section><h2>Benefit and toxicity of prior therapy</h2>Francini et al [1] lay out algorithms for treatment options on the basis of prior therapy received. In practice, when multiple treatment options exist, what is critical is not just what therapy was previously given but also how much benefit was received and what toxicities were endured. Eligibility criteria for the CARD trial included disease progression within 12 mo on a prior androgen receptor pathway inhibitor (ARPI), selecting for patients unlikely to receive a significant benefit from a</section></section><section><section><h2>Radiation and radioligand therapy in mCRPC</h2>ARPIs are relatively well tolerated and are thus ideal candidates for combination therapy. This is true for pharmacological therapy, with triplet therapy approved for metastatic HSPC and combination PARP inhibitor therapy approved for mCRPC. The ENZA-p trial showed that addition of adaptive-dosed ¹⁷⁷Lu-PSMA improved outcomes over enzalutamide alone [10]. Results from the phase 2 ARTO trial suggest that a similar strategy could be pursued with radiotherapy for patients with nonvisceral</section></section><section><section><h2>Patients’ wishes and shared decision-making</h2>Almost all patients value both quantity and quality of life, with individual patients putting more or less emphasis on each. Management decisions are made with collaboration between the patient and the treating physician. Knowledge of prior therapies and their benefit and toxicities and of molecular and clinical biomarkers can inform estimates of benefit from future therapies. Ultimately, a shared decision between the treating physician and the patient helps patients best accomplish their goals.</section></section>","PeriodicalId":12223,"journal":{"name":"European urology","volume":null,"pages":null},"PeriodicalIF":23.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142450255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}