European urology最新文献

{"title":"Expanding the Reach of FGFR Inhibitors to Advance Precision Medicine in Urothelial Carcinoma","authors":"Vadim S. Koshkin , Guru P. Sonpavde","doi":"10.1016/j.eururo.2024.11.001","DOIUrl":"10.1016/j.eururo.2024.11.001","url":null,"abstract":"","PeriodicalId":12223,"journal":{"name":"European urology","volume":"87 2","pages":"Pages 123-124"},"PeriodicalIF":25.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684619","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":"Pelvic Lymph Node Dissection in Prostate Cancer: Update from a Randomized Clinical Trial of Limited Versus Extended Dissection","authors":"Karim A. Touijer ,&nbsp;Emily A. Vertosick ,&nbsp;Daniel D. Sjoberg ,&nbsp;Nicole Liso ,&nbsp;Sunny Nalavenkata ,&nbsp;Barbara Melao ,&nbsp;Vincent P. Laudone ,&nbsp;Behfar Ehdaie ,&nbsp;Brett Carver ,&nbsp;James A. Eastham ,&nbsp;Peter T. Scardino ,&nbsp;Andrew J. Vickers","doi":"10.1016/j.eururo.2024.10.006","DOIUrl":"10.1016/j.eururo.2024.10.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>Lymph node dissection (LND) has been standard in cancer surgery for more than a century, yet evidence from randomized trials showing a benefit is scarce. We conducted a clinically integrated randomized trial comparing limited versus extended pelvic LND (PLND) during radical prostatectomy and previously reported comparable biochemical recurrence (BCR) rates. We report updated BCR rates and compare rates of metastasis between the study arms.</div></div><div><h3>Methods</h3><div>Between October 2011 and March 2017, 1432 patients undergoing radical prostatectomy were enrolled at a single center. Surgeons were cluster randomized to perform limited (external iliac nodes) or extended PLND (external iliac, obturator, and hypogastric nodes) with crossover for 3-mo periods. Cox proportional-hazards regression with robust standard errors clustered by surgeon was used to assess whether the PLND template affected BCR or distant or locoregional metastasis.</div></div><div><h3>Key findings and limitations</h3><div>There were 452 BCR events at median follow-up of 4.2 yr for participants who did not develop BCR. The results confirm our previous finding of comparable BCR rates between the arms (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.97–1.13; <em>p</em> = 0.3). However, with 123 metastasis events and median follow-up of 5.4 yr for patients without metastasis, we found a clinically and statistically significant protective effect of extended PLND against metastasis (any metastasis: HR 0.82, 95% CI 0.71–0.93; <em>p</em> = 0.003; distant metastasis: HR 0.75, 95% CI 0.64–0.88; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions and clinical implications</h3><div>Patients undergoing radical prostatectomy should receive extended PLND that includes the external iliac, obturator, and hypogastric nodes. Further research should examine biological mechanisms regarding the anatomic location of affected nodes. Trials of LND for other cancers are warranted and should consider our clinically integrated design.</div><div>This trial is registered on ClinicalTrials.gov as NCT01407263.</div></div>","PeriodicalId":12223,"journal":{"name":"European urology","volume":"87 2","pages":"Pages 253-260"},"PeriodicalIF":25.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142536555","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":"What’s in a Name? Why Words Matter in Advanced Prostate Cancer","authors":"William K. Oh ,&nbsp;Neeraj Agarwal ,&nbsp;Alan Bryce ,&nbsp;Pedro Barata ,&nbsp;Courtney Bugler ,&nbsp;Sigrid V. Carlsson ,&nbsp;Brad Cornell ,&nbsp;William Dahut ,&nbsp;Daniel George ,&nbsp;Stacy Loeb ,&nbsp;Bruce Montgomery ,&nbsp;David Morris ,&nbsp;Lorelei A. Mucci ,&nbsp;Aurelius Omlin ,&nbsp;Ganesh Palapattu ,&nbsp;Irbaz Bin Riaz ,&nbsp;Charles Ryan ,&nbsp;Martin W. Schoen ,&nbsp;Samuel L. Washington III ,&nbsp;Silke Gillessen","doi":"10.1016/j.eururo.2024.10.017","DOIUrl":"10.1016/j.eururo.2024.10.017","url":null,"abstract":"","PeriodicalId":12223,"journal":{"name":"European urology","volume":"87 2","pages":"Pages 101-103"},"PeriodicalIF":25.3,"publicationDate":"2025-02-01","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":"Genomic Classifiers To Guide Postprostatectomy Radiation Therapy: An Opening Movement in G-MINOR","authors":"Scott Eggener ,&nbsp;Stanley L. Liauw","doi":"10.1016/j.eururo.2024.11.017","DOIUrl":"10.1016/j.eururo.2024.11.017","url":null,"abstract":"","PeriodicalId":12223,"journal":{"name":"European urology","volume":"87 2","pages":"Pages 238-239"},"PeriodicalIF":25.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142753064","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 of Patients with Advanced Prostate Cancer. Report from the 2024 Advanced Prostate Cancer Consensus Conference (APCCC)","authors":"Silke Gillessen ,&nbsp;Fabio Turco ,&nbsp;Ian D. Davis ,&nbsp;Jason A. Efstathiou ,&nbsp;Karim Fizazi ,&nbsp;Nicholas D. James ,&nbsp;Neal Shore ,&nbsp;Eric Small ,&nbsp;Matthew Smith ,&nbsp;Christopher J. Sweeney ,&nbsp;Bertrand Tombal ,&nbsp;Thomas Zilli ,&nbsp;Neeraj Agarwal ,&nbsp;Emmanuel S. Antonarakis ,&nbsp;Ana Aparicio ,&nbsp;Andrew J. Armstrong ,&nbsp;Diogo Assed Bastos ,&nbsp;Gerhardt Attard ,&nbsp;Karol Axcrona ,&nbsp;Mouna Ayadi ,&nbsp;Aurelius Omlin","doi":"10.1016/j.eururo.2024.09.017","DOIUrl":"10.1016/j.eururo.2024.09.017","url":null,"abstract":"<div><h3>Background and objective</h3><div>Innovations have improved outcomes in advanced prostate cancer (PC). Nonetheless, we continue to lack high-level evidence on a variety of topics that greatly impact daily practice. The 2024 Advanced Prostate Cancer Consensus Conference (APCCC) surveyed experts on key questions in clinical management in order to supplement evidence-based guidelines. Here we present voting results for questions from APCCC 2024.</div></div><div><h3>Methods</h3><div>Before the conference, a panel of 120 international PC experts used a modified Delphi process to develop 183 multiple-choice consensus questions on eight different topics. Before the conference, these questions were administered via a web-based survey to the voting panel members (“panellists”).</div></div><div><h3>Key findings and limitations</h3><div>Consensus was a priori defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. The voting results show varying degrees of consensus, as discussed in this article and detailed in the Supplementary material. These findings do not include a formal literature review or meta-analysis.</div></div><div><h3>Conclusions and clinical implications</h3><div>The voting results can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers in prioritising areas for future research. Diagnostic and treatment decisions should always be individualised on the basis of patient and cancer characteristics, and should incorporate current and emerging clinical evidence, guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2024 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials.</div></div>","PeriodicalId":12223,"journal":{"name":"European urology","volume":"87 2","pages":"Pages 157-216"},"PeriodicalIF":25.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Predicting Non-muscle Invasive Bladder Cancer Outcomes Using Artificial Intelligence: A Systematic Review Using APPRAISE-AI","authors":"Marc Colombel","doi":"10.1016/j.eururo.2024.08.004","DOIUrl":"10.1016/j.eururo.2024.08.004","url":null,"abstract":"","PeriodicalId":12223,"journal":{"name":"European urology","volume":"87 2","pages":"Page 265"},"PeriodicalIF":25.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038021","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 ,&nbsp;Jeremie Calais ,&nbsp;Arturo Chiti ,&nbsp;Louise Emmett ,&nbsp;Stefano Fanti ,&nbsp;Wolfgang Fendler ,&nbsp;Ken Herrmann ,&nbsp;Thomas A. Hope ,&nbsp;Oliver Sartor ,&nbsp;Brian Shuch ,&nbsp;Scott Tagawa ,&nbsp;Michael S. Hofman","doi":"10.1016/j.eururo.2024.09.036","DOIUrl":"10.1016/j.eururo.2024.09.036","url":null,"abstract":"<div><h3>Background and objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Key findings and limitations</h3><div>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.</div></div><div><h3>Conclusions and clinical implications</h3><div>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.</div></div>","PeriodicalId":12223,"journal":{"name":"European urology","volume":"87 2","pages":"Pages 125-139"},"PeriodicalIF":25.3,"publicationDate":"2025-02-01","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":"Intraductal Carcinoma and Cribriform Pattern in Prostate Cancer: Challenges and Emerging Perspectives","authors":"Rui M. Bernardino, Theodorus van der Kwast, Neil E. Fleshner","doi":"10.1016/j.eururo.2025.01.013","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.01.013","url":null,"abstract":"&lt;h2&gt;Section snippets&lt;/h2&gt;&lt;section&gt;&lt;section&gt;&lt;h2&gt;Limitations of current strategies for IDC/Crib detection&lt;/h2&gt;Reliable detection of these aggressive subtypes remains difficult, as conventional biopsy has demonstrated limited sensitivity. Data from matched biopsy and RP studies indicate that traditional biopsy methods (with or without magnetic resonance imaging [MRI] fusion) have sensitivity as low as 42% for Crib and 44% for IDC detection [4]. Sampling bias in biopsies may explain this, as they are more likely to detect extensive IDC/Crib. In addition, the difficulty in sampling the anterior zone via&lt;/section&gt;&lt;/section&gt;&lt;section&gt;&lt;section&gt;&lt;h2&gt;Clinical implications of failure to detect IDC/Crib&lt;/h2&gt;The landscape of PCa management has evolved, with an emphasis now on risk-adapted approaches that balance treatment intensity with quality-of-life considerations. Active surveillance (AS) is increasingly adopted for favorable intermediate-risk PCa, particularly grade group 2 [GS 7 (3 + 4)], as supported by emerging studies and recognition that not all intermediate-risk cases involve aggressive progression [7]. According to the European Association of Urology guidelines, AS is inappropriate for&lt;/section&gt;&lt;/section&gt;&lt;section&gt;&lt;section&gt;&lt;h2&gt;IDC/Crib in high-risk PCa&lt;/h2&gt;In a study by Yu et al [8], IDC or Crib morphology was observed in 95% of RP specimens with nodal metastases and was a strong independent predictor of prognosis. Incorporation of IDC/Crib in Cancer of the Prostate Risk Assessment and National Comprehensive Cancer Network models enhances their predictive accuracy for BCR after RP, particularly in high-risk and very high-risk groups. This emphasizes the critical need for pathologists to document these features, particularly in cases with biopsy&lt;/section&gt;&lt;/section&gt;&lt;section&gt;&lt;section&gt;&lt;h2&gt;Imaging for detection of metastasis in IDC/Crib&lt;/h2&gt;Prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET)/computed tomography (CT) is increasingly being used in BCR and pretreatment settings. The higher sensitivity of this imaging modality reveals novel metastatic patterns, adding complexity to stage migration [9], [10]. IDC presence in RP specimens correlates with higher likelihood of metastasis on PSMA PET/CT. Among patients with metastasis detected on PSMA PET/CT, Crib is particularly associated with lymphatic&lt;/section&gt;&lt;/section&gt;&lt;section&gt;&lt;section&gt;&lt;h2&gt;Molecular alterations in IDC/Crib&lt;/h2&gt;Both Crib and IDC exhibit higher rates of genetic instability and copy number alterations, frequently involving mutations in key tumor suppressor genes and oncogenes such as &lt;em&gt;PTEN&lt;/em&gt; (commonly lost in IDC), &lt;em&gt;TP53&lt;/em&gt;, &lt;em&gt;BRCA2&lt;/em&gt;, &lt;em&gt;ATM&lt;/em&gt;, &lt;em&gt;RB1&lt;/em&gt;, and &lt;em&gt;SPOP&lt;/em&gt;. Oncogenic pathway deregulation events, including &lt;em&gt;MYC&lt;/em&gt; amplification and alterations in the PI3K-AKT-mTOR, JAK-STAT, KRAS, and MAPK pathways, drive tumor progression in these patterns [11]. These molecular changes underscore the aggressive nature of IDC/Crib and&lt;/","PeriodicalId":12223,"journal":{"name":"European urology","volume":"79 1 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071695","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":"Final Overall Survival and Molecular Data Associated with Clinical Outcomes in Patients Receiving Ipatasertib and Abiraterone in the Phase 3 IPATential150 Trial","authors":"Johann S. de Bono, Meng He, Zhen Shi, Malgorzata Nowicka, Sergio Bracarda, Cora N. Sternberg, Kim N. Chi, David Olmos, Shahneen Sandhu, Christophe Massard, Nobuaki Matsubara, Geng Chen, Nives Selak Bienz, Daniel Canter, Matthew Wongchenko, Christopher Sweeney","doi":"10.1016/j.eururo.2024.12.015","DOIUrl":"https://doi.org/10.1016/j.eururo.2024.12.015","url":null,"abstract":"<h3>Background and objective</h3>In the phase 3 IPATential150 trial, ipatasertib addition to abiraterone significantly reduced the risk of disease progression in men with metastatic castration-resistant prostate cancer (mCRPC) with PTEN loss on immunohistochemistry (IHC), but not in the intention-to-treat (ITT) population. Here we report the final overall survival (OS) analysis and present results for prespecified and exploratory biomarker analyses.<h3>Methods</h3>Patients were randomized to receive ipatasertib (400 mg once daily) or placebo. All patients received abiraterone (1000 mg once daily) and prednisone (5 mg twice daily). OS was assessed in patients with PTEN loss on IHC and the ITT population. Exploratory biomarker analyses included <em>PTEN</em> status via next-generation sequencing (NGS) and other key genomic alterations.<h3>Key findings and limitations</h3>At final analysis (median follow-up 33.9 mo), ipatasertib addition did not improve OS for patients with PTEN loss in IHC (<em>n</em> = 521; stratified hazard ratio [sHR] 0.94, 95% confidence interval [CI] 0.76–1.17; <em>p</em> = 0.57) or the ITT population (<em>n</em> = 1101; sHR 0.91, 95% CI 0.79–1.07; not formally tested). Exploratory NGS assessments identified subgroups with genomic <em>PTEN</em> loss (<em>n</em> = 208) or <em>PIK3CA</em>/<em>AKT1</em>/<em>PTEN</em> alterations (<em>n</em> = 250), with potentially better outcomes from ipatasertib (HR 0.76, 95% CI 0.54–1.07; and HR 0.70, 95% CI 0.51–0.96, respectively). Limitations include the exploratory nature of the analysis, incomplete availability of NGS data, and potential intrapatient heterogeneity.<h3>Conclusions and clinical implications</h3>Ipatasertib addition to abiraterone did not improve OS for men with mCRPC, regardless of PTEN status on IHC. Exploratory biomarker analyses identified additional genomic alterations of potential clinical relevance for AKT blockade in mCRPC that require further validation in prospective studies.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"39 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056966","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":"The Cost of Bladder Cancer: What Can Be Done?","authors":"Arnulf Stenzl","doi":"10.1016/j.eururo.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.01.006","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"106 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143055150","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}