European Urology Open Science最新文献

{"title":"Unlocking New Therapeutic Strategies in Oligometastatic Prostate Cancer with Radioligand and Metastasis-directed Radiation Therapy","authors":"Salvatore Cozzi ,&nbsp;Camille Roukoz ,&nbsp;Thomas Zilli","doi":"10.1016/j.euros.2025.10.002","DOIUrl":"10.1016/j.euros.2025.10.002","url":null,"abstract":"<div><div>By delivering targeted radiation to tumor cells with a minimal impact on healthy tissues, radioligand therapy (RLT) has become an established treatment for metastatic castration-resistant prostate cancer. Its combination with external beam radiotherapy (EBRT) offers potential synergy: EBRT achieves high-dose, conformal local irradiation, whereas RLT can target systemic disease. This complementary approach could delay disease progression and improve local control, particularly in the oligometastatic setting. Emerging evidence supports the feasibility and safety of this approach, but prospective data remain limited. We summarize the current clinical landscape for this setting and pivotal ongoing trials investigating RLT + EBRT combinations for metachronous oligometastatic hormone-sensitive prostate cancer, with a focus on rationale, treatment sequencing, and future directions.</div></div><div><h3>Patient summary</h3><div>In metastatic prostate cancer, the disease may spread to only a few sites in some cases, which is called oligometastatic prostate cancer (omPC). We describe a combined treatment strategy for patients with omPC. Radiotherapy targets tumors in specific areas, while radioligand therapy (which involves injection of a radioactive drug) can reach cancer cells throughout the body. Combining these two treatments may improve cancer control for both the primary tumor and metastases.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 61-64"},"PeriodicalIF":4.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145322979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Shalender Bhasin, Peter J. Snyder. Testosterone Treatment in Middle-aged and Older Men with Hypogonadism. N Engl J Med 2025;393:581–91","authors":"Yu-Hsiang Lin ,&nbsp;Jau-Yuan Chen ,&nbsp;Chun-Te Wu","doi":"10.1016/j.euros.2025.10.003","DOIUrl":"10.1016/j.euros.2025.10.003","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 59-60"},"PeriodicalIF":4.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraductal Carcinoma Predicts Poor Response to Neoadjuvant Therapy in High-risk Prostate Cancer: A Retrospective Analysis of a Prospective Trial","authors":"Rui M. Bernardino ,&nbsp;Leyi B. Yin ,&nbsp;Katherine Lajkosz ,&nbsp;Eric Winquist ,&nbsp;Jessica G. Cockburn ,&nbsp;Pocharapong Jenjitranant ,&nbsp;Rosette Veloso ,&nbsp;Clare ÓConnell ,&nbsp;Aurora Mejia Benitez ,&nbsp;David-Dan Nguyen ,&nbsp;Rune Matthiesen ,&nbsp;Rui Henrique ,&nbsp;Anthony M. Joshua ,&nbsp;Theodorus van der Kwast ,&nbsp;Neil E. Fleshner","doi":"10.1016/j.euros.2025.09.015","DOIUrl":"10.1016/j.euros.2025.09.015","url":null,"abstract":"<div><h3>Background and objective</h3><div>High-risk localized prostate cancer (PCa) patients may require neoadjuvant treatment (androgen deprivation therapy [ADT] plus abiraterone with or without taxane-based chemotherapy) before radical prostatectomy (RP). Intraductal carcinoma of the prostate (IDC) is an aggressive histological variant of prostate adenocarcinoma. This study aims to evaluate the association of IDC on biopsy with pathological response in such PCa patients.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted using the prospective trial data from 75 patients with high-risk localized/locally advanced PCa treated with 24 wk of neoadjuvant therapy comprising ADT and abiraterone, with or without taxane-based chemotherapy, followed by RP. Pathological responses, including pathological complete response (pCR), minimal residual disease (MRD), and adverse pathology outcomes (ypN1 or ≥ypT3b), were analyzed. Multivariable logistic regression identified the predictors of poor pathological response.</div></div><div><h3>Key findings and limitations</h3><div>Among 75 patients, 35 (47%) had IDC on biopsy. Patients with IDC had worse pathological outcomes: 32 of 35 (91%) failed to achieve a favorable response (pCR or MRD) compared with 26 of 40 (65%) in those without IDC. IDC was also associated with higher rates of adverse pathology at RP, occurring in 27 of 35 patients (77%) versus nine of 40 patients (22%) without IDC. IDC independently predicted poor response (odds ratio 6.18, 95% confidence interval 1.16–32.8; <em>p</em> = 0.032) after adjusting for tumor volume, Gleason grade, and prostate-specific antigen (PSA). In contrast, cribriform (Crib) pattern at biopsy did not impact response significantly. Metastatic progression and survival data were unavailable.</div></div><div><h3>Conclusions and clinical implications</h3><div>IDC, but not Crib, on biopsy predicts poor pathological response to neoadjuvant therapy (ADT plus abiraterone with or without taxane-based chemotherapy) in high-risk PCa after adjusting for tumor volume and PSA. An understanding of this treatment-resistant phenotype will improve PCa biology insights and guide novel therapeutic strategies.</div></div><div><h3>Patient summary</h3><div>Intraductal carcinoma (IDC) is a more aggressive form of prostate cancer that does not respond well to treatment. In our study, we found that 91% of patients who had IDC detected in their biopsy before surgery did not show a good response to presurgery therapy.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 52-58"},"PeriodicalIF":4.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145322981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Urinary Tract Infection with Perineal Urethrostomy Versus Urethroplasty","authors":"Yishai H. Rappaport ,&nbsp;Nir Rahav ,&nbsp;Boris Chertin ,&nbsp;Ofer Z. Shenfeld","doi":"10.1016/j.euros.2025.09.011","DOIUrl":"10.1016/j.euros.2025.09.011","url":null,"abstract":"<div><h3>Background and objective</h3><div>Perineal urethrostomy (PU) is performed for urethral strictures in patients with high risk and those with complex strictures, such as after failure of urethroplasty. After PU, the neourethral meatus is located in the perineum in proximity to the anus, which may theoretically increase the risk of urinary tract infection (UTI). Our aim was to examine UTI rates among PU patients.</div></div><div><h3>Methods</h3><div>Medical records for PU patients between 2004 and 2023 were analyzed for UTI incidence. A control group comprised patients with similar complex urethral strictures who underwent substitution or augmented urethroplasty. The primary endpoint was the incidence of recurrent UTI (rUTI), defined according to the European Association of Urology guidelines, or the use of prophylactic treatment for UTI. Data for chronic asymptomatic bacteriuria, UTI events, and urethral dilation were recorded. Analyses included t tests and Wilcoxon signed-rank tests for continuous variables, and Fisher’s exact test for categorical variables.</div></div><div><h3>Key findings</h3><div>There were 67 patients in the PU group and 66 in the control group, with median age of 51 yr (interquartile range 39–61) and 42 yr (interquartile range 29–58), respectively. Follow up was 32 mo for the PU group and 76 mo for the control group. The rUTI incidence rate was 21% in both groups. Repeat urethral dilation was required in five patients in the PU group and six in the control group (<em>p</em> = 0.78). Asymptomatic bacteriuria was observed in four patients in the PU group and six in the control group (<em>p</em> = 0.74). Overall, 21 patients in the PU group and 24 in the control group experienced a UTI event treated with antibiotics (<em>p</em> = 0.71).</div></div><div><h3>Conclusions and clinical implications</h3><div>PU does not increase the risk of UTI in comparison to urethroplasty for complex urethral strictures.</div></div><div><h3>Patients summary</h3><div>We looked at the rate of urinary tract infection after two different surgical treatments (called perineal urethrostomy [PU] and urethroplasty [UTP]) for complex urethral stricture in men, which is a narrowing of the tube draining urine from the bladder. Infection rates did not differ between the PU and UTP techniques, but were higher than in the general population. When choosing between treatment options for this condition, the PU technique does not have higher risk of urinary tract infection than UTP.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 8-12"},"PeriodicalIF":4.5,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145322977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-life Use of Cabozantinib in Front-line therapy for Metastatic Renal Cell Carcinoma: The CabFRONT Study (Meet-URO 24)","authors":"Marco Stellato ,&nbsp;Pierangela Sepe ,&nbsp;Enrico Bronte ,&nbsp;Vincenza Conteduca ,&nbsp;Maria Cossu Rocca ,&nbsp;Ugo De Giorgi ,&nbsp;Marilena Di Napoli ,&nbsp;Luca Galli ,&nbsp;Lorena Incorvaia ,&nbsp;Luca Lalli ,&nbsp;Brigida Anna Maiorano ,&nbsp;Marco Maruzzo ,&nbsp;Alessia Mennitto ,&nbsp;Giandomenico Roviello ,&nbsp;Matteo Santoni ,&nbsp;Mariella Sorarù ,&nbsp;Elisa Zanardi ,&nbsp;Paolo Zucali ,&nbsp;Giuseppe Procopio ,&nbsp;Elena Verzoni","doi":"10.1016/j.euros.2025.09.014","DOIUrl":"10.1016/j.euros.2025.09.014","url":null,"abstract":"<div><h3>Background and objective</h3><div>Cabozantinib remains the cornerstone for treatment of patients metastatic renal cell carcinoma (mRCC), whether pretreated with an immune-oncology (IO) agent and/or tyrosine kinase inhibitor, or treatment-naïve but ineligible for IO-based combinations.</div></div><div><h3>Methods</h3><div>CabFRONT (Meet-URO 24) was a retrospective, observational, multicentre study of a real-life population of treatment-naïve patients with intermediate-risk or poor-risk mRCC treated with cabozantinib.</div></div><div><h3>Key findings and limitations</h3><div>A total of 211 treatment- naïve patients with intermediate- or poor-risk mRCC according to the International Metastatic RCC Database Consortium criteria were included. At median follow-up of 50.4 mo (interquartile range 46.9–53.2), median progression-free survival (PFS) was 9.1 mo (interquartile range 7.4–10.4) and median overall survival (OS) was 19.8 mo (95% confidence interval [CI] 14.1–27.0). A reduced dose was not associated with significant differences in median OS (hazard ratio [HR] 1.08, 95% CI 0.77–1.52; <em>p =</em> 0.7) or PFS (HR 1.25, 95% CI 0.91–1.70; <em>p =</em> 0.16). A modified schedule because of toxicities was also not associated with significant differences in survival or progression (HR for death 0.56, 95% CI 0.25–1.28; <em>p =</em> 0.16; HR for progression or death 0.88, 95% CI 0.48–1.64; <em>p=</em> 0.7). The objective response rate according to Response Evaluation Criteria in Solid Tumours version 1.1 was 39%. The most common grade 3 adverse events were mucositis (9%), fatigue (9%), and diarrhoea (8.5%).</div></div><div><h3>Conclusions and clinical implications</h3><div>Front-line cabozantinib was effective and safe in an unselected real-life population of patients with intermediate-risk or poor-risk mRCC. Cabozantinib could be a choice for patients who cannot receive IO-based combinations or a speculative option for individuals with “early progression” on adjuvant IO.</div></div><div><h3>Patient summary</h3><div>We looked at outcomes for patients with metastatic kidney cancer treated with an inhibitor called cabozantinib in a large European population. We found that cabozantinib is active and safe, and that changes in the dose or treatment schedule because of side effects do not affect outcomes. Cabozantinib could be an option for patients who cannot receive immunotherapy for metastatic disease.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 1-7"},"PeriodicalIF":4.5,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145322978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application Effect of Different Robotic Surgery Systems in Radical Prostatectomy: A Comparative Study Based on a Network Meta-analysis","authors":"Jian-Wei Yang ,&nbsp;Li Wang ,&nbsp;Si-Yu Chen ,&nbsp;Shun Wan ,&nbsp;Kun-Peng Li ,&nbsp;Liang Zhao ,&nbsp;Jin Chai ,&nbsp;Li Yang","doi":"10.1016/j.euros.2025.09.012","DOIUrl":"10.1016/j.euros.2025.09.012","url":null,"abstract":"<div><h3>Background and objective</h3><div>Prostate cancer (PCa) continues to pose significant public health challenges, with rising incidence and mortality rates. Robot-assisted surgery has become a preferred method for radical prostatectomy (RP) due to its precision and minimal invasiveness. This study aims to evaluate the clinical performance of four robotic surgical systems—Da Vinci (DV), KangDuo (KD), Hugo (HG), and Hinotori—in RP for PCa using a network meta-analysis (NMA).</div></div><div><h3>Methods</h3><div>We conducted a systematic review and NMA according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, including studies published until January 2025. Studies comparing the four robotic systems in RP for PCa were included, with outcomes including operative time, blood loss, length of hospital stay, complications, 3-mo urinary incontinence rates, and positive surgical margin rates. Data were extracted from randomized controlled trials and observational studies, and statistical analyses were performed using Stata version 18.</div></div><div><h3>Key findings and limitations</h3><div>A total of 2064 patients from 15 studies were included. The results showed that the DV system had the shortest operative time (surface under the cumulative ranking curve [SUCRA] score: 90.7), while the KD system exhibited the longest operative time. There were no significant differences in estimated blood loss, hospital stay, or complication rates between the systems. The KD system showed a slight advantage in hospital stay (SUCRA score: 85.8), while the HG system had the lowest complication rate (SUCRA score: 84.3). No significant differences were found in positive surgical margin rates or 3-mo urinary incontinence rates among the systems.</div></div><div><h3>Conclusions and clinical implications</h3><div>The DV system demonstrated superior efficiency in terms of operative time, while the KD system showed potential advantages in postoperative recovery. However, all robotic systems provided similar safety profiles in terms of blood loss, complications, and long-term functional outcomes. These findings suggest that robotic systems can be selected based on clinical priorities, with further studies needed to optimize system performance and guide personalized treatment strategies.</div></div><div><h3>Patient summary</h3><div>This network meta-analysis compares four robotic surgical systems—Da Vinci, KangDuo, Hugo, and Hinotori—for prostate cancer patients. All platforms achieved comparable outcomes. However, the Da Vinci system demonstrated superior efficiency in terms of operative time, while the KangDuo system showed better postoperative recovery and blood loss control. These findings support safe integration of robotic surgical systems into clinical practice.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 25-40"},"PeriodicalIF":4.5,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noniatrogenic Urethral Trauma in Children: A Narrative Review","authors":"Rianne J.M. Lammers ,&nbsp;Tudor Enache ,&nbsp;Sebastien Faraj ,&nbsp;Mieke Waterschoot ,&nbsp;Sibel Tiryaki","doi":"10.1016/j.euros.2025.09.016","DOIUrl":"10.1016/j.euros.2025.09.016","url":null,"abstract":"<div><h3>Background and objective</h3><div>Pediatric urethral trauma is rare, and treatment recommendations are often extrapolated from evidence for adults. We conducted a systematic review of the literature to evaluate management strategies, outcomes, and the quality of reporting for pediatric urethral trauma.</div></div><div><h3>Methods</h3><div>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified 31 relevant studies published since 1990. Studies were eligible for inclusions if they reported results for five or more patients with at least 3 mo of follow-up for noniatrogenic urethral trauma. Methodological quality was assessed using the Methodological Index for Nonrandomized Studies (MINORS) tool.</div></div><div><h3>Key findings and limitations</h3><div>The quality of evidence was low: most studies were retrospective single-center cohorts and there was inconsistent reporting of management and outcomes. Open reconstruction was reported more frequently than endoscopic management. Across treatment modalities, the overall stricture rate was ∼20%. Continence and sexual function outcomes were generally favorable. However, data on repeat surgery and quality of life were insufficient for firm conclusions.</div></div><div><h3>Conclusions and clinical implications</h3><div>The most striking finding from our review is the poor quality and inconsistency of the literature on pediatric urethral trauma. As well as summarizing the outcome data available, we provide a table of recommendations for improving future studies, including the use of standardized definitions, validated pediatric patient-reported outcome measures, and consistent long-term follow-up.</div></div><div><h3>Patient summary</h3><div>We looked at the evidence on treatments and outcomes after accidental damage to the urethra in children. No definitive conclusions can be drawn because the quality of the research is low and inconsistent. We provide advice for future research.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 41-51"},"PeriodicalIF":4.5,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Interplay of Cumulative Perioperative Morbidity and Health-related Quality of Life After Radical Cystectomy—Prospective Evidence from the COMPACT Registry","authors":"Mara Koelker ,&nbsp;Sandra Trepte ,&nbsp;Jakob Klemm,&nbsp;Markus von Deimling,&nbsp;Hanna Kukuk,&nbsp;Andreas Wirtz,&nbsp;Adrian Pachollek,&nbsp;Felix Luebbersmeyer,&nbsp;Tim A. Ludwig,&nbsp;Roland Dahlem,&nbsp;Margit Fisch,&nbsp;Malte W. Vetterlein","doi":"10.1016/j.euros.2025.09.013","DOIUrl":"10.1016/j.euros.2025.09.013","url":null,"abstract":"<div><h3>Background and objective</h3><div>Radical cystectomy (RC) in bladder cancer patients is associated with considerable short-term morbidity. Although RC is known to impair health-related quality of life (HRQOL), the impact of complication severity on HRQOL in the long term remains unclear. The aim of this study is to investigate the relationship between perioperative cumulative complication burden and HRQOL after RC using data from a prospective registry, given the limited existing evidence.</div></div><div><h3>Methods</h3><div>The Comprehensive Outcome Measures and Perioperative Morbidity After CystecTomy (COMPACT) registry (DRKS00024929) prospectively collects standardized data on perioperative morbidity and longitudinal patient-reported outcome measures. The study includes patients undergoing open RC with pelvic lymph node dissection and urinary diversion for bladder cancer. According to the European Association of Urology guidelines, 90-d morbidity was assessed using both the Clavien-Dindo classification (CDC) and the Comprehensive Complication Index (CCI). HRQOL was measured at baseline and 3, 6, and 12 mo using the Functional Assessment of Cancer Therapy—Bladder—Cystectomy (FACT-BL-CYS) scores (range 0–168). Patients treated between 2020 and 2022 were included. Multivariable linear regression was used to evaluate the associations of 90-d CDC grade ≥IIIb (ie, “major complications”) and 90-d CCI with the 6-mo FACT-BL-CYS total score, adjusting for clinical and pathological confounders.</div></div><div><h3>Key findings and limitations</h3><div>Among 82 patients, one (1.2%) had no complications, and 47 (57%) had CDC grade ≤II, 22 (27%) grade III, and 11 (13%) grade IV complications. The 90-d mortality rate was 1.2%. The median 90-d CCI was 35 (interquartile range [IQR] 26–45). The median 6-mo FACT-BL-CYS total score was 119 (IQR 90–142). Only comorbidity (age-adjusted Charlson index) was significantly associated with HRQOL (coefficient: –4.76, <em>p</em> = 0.02); neither CDC ≥IIIb (<em>p</em> = 0.7) nor CCI (<em>p</em> = 0.2) was significant. Limitations include uncertainty in effect sizes due to the low number of major complications.</div></div><div><h3>Conclusions and clinical implications</h3><div>Open RC is associated with a high rate of perioperative complications when assessed with standardized methods. However, our findings suggest that their impact on HRQOL at 6 mo is limited. HRQOL appears to be more closely related to age-adjusted comorbidity. These insights should inform preoperative counseling and guide individualized postoperative care planning.</div></div><div><h3>Patient summary</h3><div>We looked at whether complications after bladder removal surgery (radical cystectomy) affect patients’ quality of life. We found that most patients have complications, but these usually do not reduce quality of life 6 mo after surgery. Instead, pre-existing health conditions had a stronger impact on recovery.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 13-24"},"PeriodicalIF":4.5,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145271070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world Evidence on Baseline Characteristics and Treatment in Metastatic Hormone-sensitive Prostate Cancer: Findings from the PIONEER 2.0 Big Data Investigation Group","authors":"Juan Gómez Rivas ,&nbsp;Pia Kraft ,&nbsp;Susan Evans-Axelsson ,&nbsp;Ayman Hijazy ,&nbsp;Katharina Beyer ,&nbsp;Bertrand De Meulder ,&nbsp;Alex Qinyang Liu ,&nbsp;Asieh Golozar ,&nbsp;Artsiom Harbachou ,&nbsp;Qi Feng ,&nbsp;Robert Snijder ,&nbsp;Carl Steinbeisser ,&nbsp;Sebastiaan Remmers ,&nbsp;Giorgio Gandaglia ,&nbsp;Pawel Rajwa ,&nbsp;Daniel Kotik ,&nbsp;Veeru Kasivisvanathan ,&nbsp;Muhammad I. Omar ,&nbsp;Jesús Moreno Sierra ,&nbsp;Alberto Briganti ,&nbsp;Rossella Nicoletti","doi":"10.1016/j.euros.2025.09.010","DOIUrl":"10.1016/j.euros.2025.09.010","url":null,"abstract":"<div><h3>Background and objective</h3><div>As first-line therapies for metastatic hormone-sensitive prostate cancer (mHSPC) expand, real-world insights into the baseline characteristics and treatment patterns of mHSPC patients are critical. This study characterises baseline patient profiles and treatment patterns in a multinational real-world cohort from the PIONEER 2.0 Big Data Investigation Group.</div></div><div><h3>Methods</h3><div>This longitudinal observational study utilised health records, insurance claims, and cancer registries from eight European and North American databases. Men diagnosed with mHSPC between January 2016 and December 2020 were included. First-line regimes were classified into four cohorts: (1) androgen deprivation therapy (ADT) monotherapy, (2) ADT + chemotherapy, (3) ADT + androgen receptor pathway inhibitors (ARPIs), and (4) ADT + ARPI + chemotherapy. Baseline characteristics were analysed across treatment groups, and treatment patterns were evaluated over time.</div></div><div><h3>Key findings and limitations</h3><div>A total of 69 680 mHSPC patients were identified across eight databases, of whom 71% presented with synchronous mHSPC. The median age ranged from 70 to 79 yr, and the most prevalent comorbidities were arterial hypertension peaking at 71% (OPTUM ADT monotherapy), obesity (up to 46%), and diabetes mellitus (up to 32%). Patients aged 70–79 yr were most often treated with ADT monotherapy or ADT + ARPI, whereas those aged 60–69 yr more frequently received ADT + chemotherapy or ADT + ARPI + chemotherapy. From 2016 through 2020, the adoption of ARPI-based combinations rose steadily, use of ADT + chemotherapy declined, and ADT monotherapy remained stable.</div></div><div><h3>Conclusions and clinical implications</h3><div>In this expansive real-world analysis of nearly 70 000 mHSPC patients, age and comorbidity burden emerged as the primary determinants of frontline therapy, alongside a clear shift towards the increased use of ADT + ARPI regimes from 2016 to 2020. Embedding these real-world insights into clinical guidelines and decision-making can enhance treatment personalisation, accelerate adoption of evidence-backed combinations, and ultimately enhance mHSPC patient outcomes.</div></div><div><h3>Patient summary</h3><div>In this study of nearly 70 000 men with metastatic hormone-sensitive prostate cancer, doctors’ treatment decisions were influenced strongly by patients’ age and other health issues, highlighting a growing preference for combination therapies. The findings highlight the importance of real-world evidence, which captures diverse, often under-represented, patients to complement clinical trials and guide more inclusive, evidence-based care.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"81 ","pages":"Pages 82-91"},"PeriodicalIF":4.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Outcomes of Neoadjuvant Versus Adjuvant Chemotherapy in Upper Tract Urothelial Carcinoma: A Propensity Score Overlap Weighting Analysis of a Multicenter Taiwanese Cohort","authors":"Yi-Ju Chou ,&nbsp;I-Hsuan Alan Chen ,&nbsp;Chia-Cheng Yu ,&nbsp;Hung-Lung Ke ,&nbsp;Wei-Ming Li ,&nbsp;Wun-Rong Lin ,&nbsp;Marcelo Chen ,&nbsp;Chi-Rei Yang ,&nbsp;Chi-Ping Huang ,&nbsp;Yao-Chou Tsai","doi":"10.1016/j.euros.2025.09.009","DOIUrl":"10.1016/j.euros.2025.09.009","url":null,"abstract":"<div><h3>Background and objective</h3><div>Systemic therapy can improve postoperative oncological outcomes in patients with high-risk upper tract urothelial carcinoma (UTUC). However, evidence comparing neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) remains inconclusive. This study aimed to evaluate survival outcomes between NAC and AC in UTUC patients.</div></div><div><h3>Methods</h3><div>We identified patients from the Taiwan UTUC Collaboration Database who received radical nephroureterectomy and systemic chemotherapy without distant metastasis. Patients receiving immunotherapy or with clinical stage &lt;cT2N0M0 were excluded. Propensity score overlap weighting was used to balance baseline characteristics between the NAC and AC groups. Overall (OS), cancer-specific (CSS), and recurrence-free (RFS) survival were compared.</div></div><div><h3>Key findings and limitations</h3><div>A total of 249 patients were included, with 45 receiving NAC and 204 receiving AC. After balancing baseline characteristics using overlap weighting, the NAC group showed significantly lower pathological stage, less lymph node involvement, and less lymphovascular invasion. No significant difference was observed in OS, CSS, or RFS between the groups. However, when stratified by treatment response, NAC nonresponders had significantly worse survival than AC patients. The main limitation of this study lies in its retrospective nature.</div></div><div><h3>Conclusions and clinical implications</h3><div>NAC and AC demonstrated no significant differences in survival outcomes, but response to NAC was an important prognostic factor for survival. Given the difficulty in accurately predicting a response to NAC, AC may be a more favorable treatment strategy in patients with UTUC. However, prospective randomized trials are still needed to validate our findings.</div></div><div><h3>Patient summary</h3><div>In this study, we compare the effects of two types of chemotherapy for upper tract urothelial carcinoma (UTUC): neoadjuvant chemotherapy (NAC), which is given before surgery, and adjuvant chemotherapy (AC), which is given after surgery. We found that only patients who responded well to NAC had survival outcomes similar to those who received AC. Based on this, we suggest that unless we can accurately predict who will respond to NAC, AC should be the preferred treatment for UTUC patients.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"81 ","pages":"Pages 67-81"},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}