European Urology Open Science最新文献

{"title":"Mobile-based Assessment of Entrustable Professional Activities in Urology Training: Implementation and Outcomes","authors":"Fabian J. Aschwanden ,&nbsp;Luca Afferi ,&nbsp;Lukas Kandler ,&nbsp;Adrian P. Marty ,&nbsp;Philipp Baumeister ,&nbsp;Agostino Mattei ,&nbsp;Marko Kozomara ,&nbsp;Christian D. Fankhauser","doi":"10.1016/j.euros.2025.01.013","DOIUrl":"10.1016/j.euros.2025.01.013","url":null,"abstract":"<div><h3>Background and objective</h3><div>Urology residency programs often lack consistent feedback mechanisms and tracking of an individual’s progress. Competency-based medical education, using entrustable professional activities (EPAs), offers a solution but faces challenges in implementation. The aim of this study was to implement and assess a smartphone application for real-time EPA assessments in urology residency programs.</div></div><div><h3>Methods</h3><div>A mobile application was introduced to 13 urology residents and ten supervisors at a Swiss training institution. Assessment characteristics were analyzed using descriptive statistics. Agreement between trainees and supervisors on task complexity and supervision levels was evaluated using Cohen’s and Fleiss’ κ metrics.</div></div><div><h3>Key findings and limitations</h3><div>Over a period of 7 mo, 246 EPA assessments were recorded, of which 214 assessments were completed, representing a completion rate of 86%. Procedural EPAs accounted for 92% of the assessments, and nonprocedural EPAs for 8%. Cohen’s κ indicated moderate agreement for task complexity (κ = 0.56) and supervision levels (κ = 0.55). Higher agreement was observed when trainees were rated competent in supervising others (κ = 0.71). Limitations include the focus on procedural tasks and the small sample size.</div></div><div><h3>Conclusions and clinical implications</h3><div>A mobile application can effectively facilitate real-time EPA assessments in urology training, promoting frequent feedback conversations and efficient tracking of resident progress. However, greater emphasis on nonprocedural EPAs is needed.</div></div><div><h3>Patient summary</h3><div>We tested a mobile phone app that provides real-time feedback to urology residents and found that it enhanced their training experience. While the app effectively tracks progress in carrying out procedures, more focus is needed on developing nonprocedural skills such as patient counseling.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 71-76"},"PeriodicalIF":3.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Clinical Implications of Post-obstruction Hyperdiuresis Among Patients with Urinary Retention: A Mini Review","authors":"Ursina Rigonalli ,&nbsp;Silvan Sigg ,&nbsp;Seraina Von Moos ,&nbsp;Philipp Baumeister ,&nbsp;Agostino Mattei ,&nbsp;Christian D. Fankhauser ,&nbsp;Andres Affentranger","doi":"10.1016/j.euros.2025.01.017","DOIUrl":"10.1016/j.euros.2025.01.017","url":null,"abstract":"<div><div>Urinary retention is a common urological emergency requiring catheterization. However, follow-up management remains poorly defined, particularly regarding post-obstruction hyperdiuresis (POHD), which may lead to complications such as hypovolemia and electrolyte disturbances. Our mini review of PODS identified nine relevant studies involving 665 patients. POHD occurred in 15–78% of cases, with a mean duration of 2–5 d. Risk factors included serum creatinine &gt;105 μmol/l (odds ratio [OR] 4.83, 95% confidence interval [CI] 1.14–20.44; <em>p</em> = 0.032) and greater bladder volume (OR per 100-ml increment: 1.21, 95% CI 1.06–1.40; <em>p</em> = 0.006). Complications included hematuria (11–55%), hyponatremia (22–28%), and hypotension (9%), most of which were self-limiting. Data on management were sparse; one randomized controlled trial showed no significant difference in complications between rapid and gradual decompression. The lack of standardized protocols underscores the need for further prospective studies to optimize patient outcomes.</div></div><div><h3>Patient summary</h3><div>After relief of urinary obstruction, an increase in urination is common. Complications such as blood in the urine, electrolyte imbalances, and dehydration may occur but typically resolve on their own without additional treatment.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 68-70"},"PeriodicalIF":3.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Mass Biopsy Prior to Surgical Excision: Practice, Diagnostic Performance, and Impact on Management in the UroCCR Registry (Ancillary Study No. 118)","authors":"Pauline Proye ,&nbsp;Bastien Gondran-Tellier ,&nbsp;Floriane Michel ,&nbsp;Karim Bensalah ,&nbsp;Pierre Bigot ,&nbsp;François Audenet ,&nbsp;Cécile Champy ,&nbsp;Pierre Merlin ,&nbsp;Franck Bruyere ,&nbsp;Morgan Roupret ,&nbsp;Gautier Marcq ,&nbsp;Louis Surlemont ,&nbsp;Bastien Parier ,&nbsp;Thibaut Waeckel ,&nbsp;Constance Michel ,&nbsp;Nicolas Branger ,&nbsp;Thibault Tricart ,&nbsp;Clément Sarrazin ,&nbsp;Jean-Jacques Patard ,&nbsp;Maxime Vallée ,&nbsp;Romain Boissier","doi":"10.1016/j.euros.2025.01.016","DOIUrl":"10.1016/j.euros.2025.01.016","url":null,"abstract":"<div><h3>Background and objective</h3><div>A renal mass biopsy (RMB) is not systematically recommended before surgical excision of a renal mass, although it has demonstrated elevated accuracy in determining renal masses with low morbidity. Our aim was to determine the diagnostic accuracy of an RMB, the clinical and tumoral factors associated with RMB practice, and the impact of an RMB on renal cell carcinoma management in a contemporary prospective national registry—UroCCR (2010–2021).</div></div><div><h3>Methods</h3><div>We identified all patients with a single renal mass (pT1–4 N0–2 M0 or benign) who were treated surgically and stratified them according to the performance of a prior RMB. Patients treated by active surveillance, percutaneous ablative treatment, or stereotaxic radiotherapy were excluded. Diagnostic accuracy of an RMB was determined in the RMB group. Clinical and tumoral factors associated with the practice of RMBs were analyzed using logistic regression.</div></div><div><h3>Key findings and limitations</h3><div>In total, 9283 patients were included, who presented 1594 tumors (17%) with a prior RMB. RMBs were 92.4% contributive. The correlation between an RMB and excision in the determination of benign/malignant disease, histological subtype, and grade are, respectively, 96.9%, 86.4%, and 52.6%. The impact of an RMB versus no prior RMB was determined according to the rate of surgical excision for benign lesion and the rate of partial nephrectomy (63.9% vs 57.8%; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions and clinical implications</h3><div>An RMB is performed rarely when its diagnostic performance is high. A prior RMB significantly changes the management of localized renal masses, with fewer surgical procedures for benign renal masses and conservative treatment in a higher proportion of patients.</div></div><div><h3>Patient summary</h3><div>In a large and contemporary registry, we demonstrated that a renal mass biopsy has excellent diagnostic accuracy, significantly reduces renal surgery for benign masses and low-grade/stage renal cell carcinoma, and increases conservative surgical excision.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 60-67"},"PeriodicalIF":3.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143422418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meta-analysis of Germline Whole-exome Sequencing in 1435 Cases of Testicular Germ Cell Tumour to Evaluate Disruptive Mutations Under Dominant, Recessive, and X-linked Inheritance Models","authors":"Zeid Kuzbari ,&nbsp;Charlie F. Rowlands ,&nbsp;Isaac Wade ,&nbsp;Alice Garrett ,&nbsp;Chey Loveday ,&nbsp;Subin Choi ,&nbsp;Beth Torr ,&nbsp;Kevin Litchfield ,&nbsp;Alison Reid ,&nbsp;Robert Huddart ,&nbsp;Peter Broderick ,&nbsp;Richard S. Houlston ,&nbsp;Clare Turnbull","doi":"10.1016/j.euros.2025.01.015","DOIUrl":"10.1016/j.euros.2025.01.015","url":null,"abstract":"<div><h3>Background and objective</h3><div>Testicular germ cell tumour (TGCT) is the most common cancer in young men, and over half of its high estimated heritability is unexplained. Our objective was to identify rare pathogenic germline variation driving TGCT susceptibility.</div></div><div><h3>Methods</h3><div>This study is a case-control meta-analysis of whole-exome sequencing data from three datasets (Institute of Cancer Research, The Cancer Genome Atlas, and UK Biobank). We retained unrelated male individuals of European ancestry comprising 1435 TGCT cases and 18 284 cancer-free controls. We performed gene-level association testing of protein-truncating variants and nonsynonymous disruptive variants across six candidate gene sets (733 genes) potentially biologically related to TGCT. We then analysed exome wide (19 355 genes) under dominant and recessive models, including X-linked genes.</div></div><div><h3>Key findings and limitations</h3><div>No individual gene-disease association was identified following multiple testing corrections. However, functional gene-set analyses identified an excess of associations with genes involved in microtubular/ciliary pathways (<em>p</em> = 1.69 × 10^–8). Our study was well powered to detect rare variation of moderate/high effect sizes (odds ratio [OR] ≥5), but power diminished for modest effect sizes (OR &lt;5).</div></div><div><h3>Conclusions and clinical implications</h3><div>Although this is the largest whole-exome analysis of TGCT to date and first exome-wide examination for recessively acting gene associations, larger studies are required to identify robust associations for individual genes.</div></div><div><h3>Patient summary</h3><div>We investigated samples from 1435 men with testicular cancer and 18 284 men without cancer to compare the rate of disruptive mutations in 19 355 genes. No evidence of specific genes associated with testicular cancer was discovered, although one gene group showed a strong association. Larger studies are needed to identify individual genes associated with causing testicular cancer.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 51-59"},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biochemical Hypogonadism in Aging Testicular Cancer Survivors: A Clinical Challenge","authors":"Sophie D. Fosså ,&nbsp;Lars J. Bjerner ,&nbsp;Torgrim Tandstad ,&nbsp;Marianne Brydøy ,&nbsp;Alv A. Dahl ,&nbsp;Ragnhild V. Nome ,&nbsp;Helene Negaard ,&nbsp;Tor Å. Myklebust ,&nbsp;Hege S. Haugnes","doi":"10.1016/j.euros.2024.12.010","DOIUrl":"10.1016/j.euros.2024.12.010","url":null,"abstract":"<div><h3>Background and objective</h3><div>Few longitudinal studies have described the prevalence and development of biochemical hypogonadism in aging testicular cancer survivors (TCSs) in comparison to men from the general population (control subjects).</div></div><div><h3>Methods</h3><div>Serum total and free testosterone (T_total, T_free) were measured in 593 TCSs median11 and 27 years after TC diagnosis (Survey-First; Survey-Last). Post-treatment adverse health outcomes (AHOs) were recorded. The results were compared to those in 578 control subjects. Treatment was stratified as surgery alone, radiotherapy alone, or platinum-based chemotherapy. Biochemical hypogonadism was defined as T_total &lt;8 nmol/l, or as T_total &lt;12 nmol/l and T_free &lt;225 pmol/l. We used multivariable logistic regression analysis to explore associations with age and treatment intensity. Statistical significance was set at <em>p</em> &lt;0.05.</div></div><div><h3>Key findings and limitations</h3><div>Between the first and last survey the prevalence of biochemical hypogonadism increased from 12% to 41% in the TSC group and from 5% to 11% in the control group. Three decades after diagnosis, the probability of biochemical hypogonadism was significantly correlated with increasing age and greater treatment intensity. The combined age- and treatment- related probability of hypogonadism was more than threefold higher in the TCS group than in the control group. At the last survey, fewer eugonadal than hypogonadal TCS men reported at least one AHO attributable to androgen deficiency (54% vs 72%; <em>p</em> &lt;0.001). Limitations include the availability of only one blood sample per survey wave.</div></div><div><h3>Conclusions and clinical implications</h3><div>For aging TCSs, the probability of biochemical hypogonadism depends on age and prior treatment intensity and is threefold higher than for control subjects at 30 yr after diagnosis. As late hypogonadism is associated with AHO incidence, the development of hypogonadism should be monitored via regular blood tests during TCS follow-up.</div></div><div><h3>Patient summary</h3><div>Depending on the treatment they received, older survivors of testicular cancer (TC) are at persistent risk of lower testosterone levels. Our study revealed low testosterone in 40% of TC survivors older than 60 years compared to 10% of similarly aged men from the general population. Low testosterone is associated with chronic conditions such as diabetes, fatigue, and/or erectile dysfunction. Testosterone should be regularly monitored during follow-up for TC survivors.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 10-16"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Evaluation of Robotic-assisted Radical Prostatectomy: A Systematic Review and Meta-analysis","authors":"Tanan Bejrananda ,&nbsp;Win Khaing ,&nbsp;Sajesh K. Veettil ,&nbsp;Therdpong Thongseiratch ,&nbsp;Nathorn Chaiyakunapruk","doi":"10.1016/j.euros.2025.01.011","DOIUrl":"10.1016/j.euros.2025.01.011","url":null,"abstract":"<div><h3>Background and objective</h3><div>Robotic-assisted radical prostatectomy (RARP) is a surgical option for localized prostate cancer. Cost-effectiveness analysis (CEA) findings are inconsistent when comparing it with open (ORP) and laparoscopic (LRP) radical prostatectomy approaches. We performed a systematic review and meta-analysis to pool the incremental net benefit (INB) of these approaches.</div></div><div><h3>Methods</h3><div>Relevant CEA studies of RARP were identified by searching the PubMed, Embase, Scopus, International Health Technology Assessment database, Tufts CEA Registry, and Centre for Reviews and Dissemination databases from January 2005 to October 2023. To be included, studies must compare costs, and quality-adjusted life years (QALYs) of RARP versus ORP or LRP, and report the incremental cost per QALY gained. Study characteristics, economic model, costs, and outcomes were extracted. INBs were calculated in 2022 US dollars adjusted for purchasing power parity. A pooled analysis was performed using a random-effect model stratified by country income level. Heterogeneity was assessed using the Q test and I² statistic.</div></div><div><h3>Key findings and limitations</h3><div>Thirteen studies with 17 comparisons, ten from high-income (HICs) and three from middle-income (MICs) countries, were included. Ten and five studies compared RARP with ORP and LRP, respectively. From a payer perspective, RARP was cost effective but not statistically significant compared with LRP in HICs (pooled INB: $7507.83 [–$1193.03 to $16 208.69], I² = 81.15%) and not cost effective in MICs (%; –$4499.39 [–$16 500 to $7526.87], I² = 17.15%). RARP showed no statistically significant cost effectiveness over ORP in both HICs ($3322.38 [–$1864.39 to $8509.15], I² = 90.89%) and MICs ($2222.60 [–$2960.64 to $7405.83], I² = 58.92%).</div></div><div><h3>Conclusions and clinical implications</h3><div>RARP is cost effective compared with LRP in HICs but lacks statistical significance. When compared with ORP, RARP is not cost effective in HICs and MICs. Our findings may support decision-making for prostate cancer treatment options in countries with different health care systems, especially those with limited resources.</div></div><div><h3>Patient summary</h3><div>Our systematic review and meta-analysis provide important information regarding robotic-assisted radical prostatectomy (RARP) compared with open (ORP) and laparoscopic (LRP) radical prostatectomy. In high-income countries, RARP is generally cost effective compared with LRP, but not with ORP, while in middle-income countries, RARP is not cost effective compared with LRP or ORP. The findings of this review can support decision-making for prostate cancer treatment options.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 17-28"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143369757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and Late Complications Associated with Penile Cancer Surgery and the Impact of Human Papillomavirus Status: Findings from a Retrospective Norwegian Cohort Study","authors":"Patrick Juliebø-Jones ,&nbsp;Ida M. Nordanger ,&nbsp;Christian Beisland ,&nbsp;Tor K. Thorkelsen ,&nbsp;Alfred Honoré ,&nbsp;Christian A. Moen","doi":"10.1016/j.euros.2025.01.009","DOIUrl":"10.1016/j.euros.2025.01.009","url":null,"abstract":"<div><h3>Background and objective</h3><div>Penile cancer (PeCa) and penile intraepithelial neoplasia (PeIN) are rare diseases, and the burden of complications associated with surgery remains under-reported. The objective was to evaluate the early (≤30 d) and late (&gt;30 d) complications and the impact of human papillomavirus (HPV) status.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted of a cohort consisting of 201 consecutive and treatment-naïve patients with PeCa/PeIN undergoing surgery (penile sparing, and partial and total amputation) between January 1, 2000 and December 31, 2023 at a tertiary centre as part of a centralised regional service.</div></div><div><h3>Key findings and limitations</h3><div>The median follow-up time was 39 (interquartile range 21, 76) mo. The early and late patient complication rates were 45% and 38%, respectively. Of the patients, 18.5% experienced two or more early complications. A majority (80%) of early complications were minor (Clavien-Dindo ≤2). There was a 1% admission rate to the intensive care unit, but no deaths were recorded within 30 d. Body mass index (BMI)was a significant predictor of early complications (<em>p</em> = 0.01). Late complications included chronic wound irritation (10%) and urethral stricture (11%). The latter was highest among those who had undergone partial amputation. One in four patients underwent reoperation due to recurrence during follow-up. HPV status had no association with the rate of either early or late complications.</div></div><div><h3>Conclusions and clinical implications</h3><div>PeCa surgery is associated with a relatively high complication burden, in both the early and the late postoperative period. Lymph node surgery further adds to the morbidity profile. BMI was a significant predictor of having an early complication, while HPV status did not affect the rate of early or late complications.</div></div><div><h3>Patient summary</h3><div>Penile cancer surgery is associated with a high rate of complications in early as well as late postoperative period. However, most of these complications are not severe. Body mass index was a significant predictor of an early complication, but human papillomavirus status was not associated with the risk of complications.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 29-35"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143369758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management","authors":"Riccardo Leni ,&nbsp;Emily A. Vertosick ,&nbsp;Nicole Liso ,&nbsp;Oguz Akin ,&nbsp;Sigrid V. Carlsson ,&nbsp;Francesco Montorsi ,&nbsp;Alberto Briganti ,&nbsp;James A. Eastham ,&nbsp;Samson W. Fine ,&nbsp;Andrew J. Vickers ,&nbsp;Behfar Ehdaie","doi":"10.1016/j.euros.2025.01.012","DOIUrl":"10.1016/j.euros.2025.01.012","url":null,"abstract":"<div><h3>Background and objective</h3><div>Guideline recommendations regarding early management of grade group (GG) 2 prostate cancer with confirmatory biopsy (cBx) are not well established. Our aim was to determine which patients with GG 2 cancer should undergo cBx before treatment decision-making by evaluating the probability of downgrading to GG 1 or no cancer on cBx.</div></div><div><h3>Methods</h3><div>This was a single-institution retrospective analysis of patients with GG 2 prostate cancer who underwent cBx. We modeled the probability of having no Gleason pattern 4 on cBx according to magnetic resonance imaging (MRI) Prostate Imaging-Reporting and Data System (PI-RADS) score, presence of extraprostatic extension (EPE) on MRI, total length of pattern 4 across all cores on initial Bx, and prostate-specific antigen (PSA) density.</div></div><div><h3>Key findings and limitations</h3><div>Among 301 patients, 62 (21%) were downgraded to GG 1 and 23 (8%) had no cancer on cBx. For patients with nonsuspicious MRI findings (PI-RADS 1–3; <em>n</em> = 123), the probability of having no pattern 4 on CBx was 34%, 20%, and 11% for 1, 2, and 3 mm of pattern 4 at initial Bx. For PI-RADS 4–5 without EPE on MRI (<em>n</em> = 146), the corresponding probabilities were 18%, 10%, and 5%. Patients with EPE on MRI (<em>n</em> = 32) had low probability (&lt;10%) of having no pattern 4 on cBx irrespective of pattern 4 on initial Bx. Results using a model based on PSA density followed a similar trend. After applying the model in a cohort of patients with GG 2 cancer who immediately underwent surgery (<em>n</em> = 2275), we estimated that two-thirds would be eligible for cBx before treatment using a probability threshold of 5–10% for avoiding immediate surgery.</div></div><div><h3>Conclusions and clinical implications</h3><div>Patients with GG 2 prostate cancer, no evidence of EPE, and a few millimeters of pattern 4 should undergo cBx before proceeding to surgery. Further research should define the oncologic risk for such patients, refine the criteria for cBx in GG 2 disease, and assess methods for quantifying pattern 4 length in MRI-targeted cores.</div></div><div><h3>Patient summary</h3><div>For patients with grade group (GG) 2 prostate cancer, we found that the amount of Gleason pattern 4 cancer in the initial biopsy, PSA (prostate-specific antigen) density, and MRI (magnetic resonance imaging) findings help to identify men who are likely to be downgraded to less aggressive GG 1 cancer or no cancer at all on a repeat confirmatory biopsy. We assessed these predictors in a group of patients with similar characteristics who underwent immediate surgery, and found that approximately two-thirds would benefit from a confirmatory biopsy.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 46-53"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Focal Therapy to Lesions Detected via Magnetic Resonance Imaging: Delivering Cancer Ablation Beyond the Visibility Phenomenon","authors":"Clement Orczyk ,&nbsp;Teresa Marsden ,&nbsp;Francesco Giganti ,&nbsp;Joseph M. Norris ,&nbsp;Santosh Waigankar ,&nbsp;Louise Dickinson ,&nbsp;Shonit Punwani ,&nbsp;Alex Kirkham ,&nbsp;Alex Freeman ,&nbsp;Aiman Haider ,&nbsp;Caroline M. Moore ,&nbsp;Arnauld Villers ,&nbsp;Clare Allen ,&nbsp;Mark Emberton","doi":"10.1016/j.euros.2025.01.010","DOIUrl":"10.1016/j.euros.2025.01.010","url":null,"abstract":"<div><div>The inclusion of imaging as a triage test in diagnostic guidelines for prostate cancer (PC) has introduced a visible target for guiding treatment allocation and disease management. Focal therapy (FT) is a promising approach with a low side-effect profile for treating magnetic resonance imaging (MRI)-visible PC within a limited framework of guideline recommendations or clinical trials. On the basis of accumulated clinical and research experience, we present a systematic approach to FT indications for ablation of visible targets that includes imaging findings, margin delineation, and energy selection. Confirmation of eligibility for FT is associated with the choice of energy source. We propose a 10-step framework that incorporates the contribution of all MRI sequences, the cancer growth pattern within the zonal anatomy to establish a margin around the MRI-visible lesion, safeguards for critical anatomic structures, and guidance for energy selection on the basis of specific properties. We discuss the key principles underlying this process. The aim of this methodology is to standardise FT interventions for MRI-visible PC and contribute to the development of a reproducible, stable treatment protocol. Quality control of the ablation procedure is crucial for broadening access to this technique beyond the confines of current regulatory pathways.</div></div><div><h3>Patient summary</h3><div>We propose a method for using results from magnetic resonance imaging (MRI) scans to guide targeted treatment of visible prostate cancer lesions. This will help to ensure accurate coverage and eradication of all of the cancer while minimising side effects.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 36-41"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk of Thromboembolic and Cardiovascular Adverse Events with PARP Inhibitor Treatment in Patients with Metastatic Castration-resistant Prostate Cancer: A Systematic Review and Safety Meta-analysis","authors":"Brigida Anna Maiorano ,&nbsp;Martina Catalano ,&nbsp;Chiara Mercinelli ,&nbsp;Antonio Cigliola ,&nbsp;Valentina Tateo ,&nbsp;Neeraj Agarwal ,&nbsp;Shilpa Gupta ,&nbsp;Giandomenico Roviello ,&nbsp;Andrea Necchi","doi":"10.1016/j.euros.2024.12.008","DOIUrl":"10.1016/j.euros.2024.12.008","url":null,"abstract":"<div><h3>Background and objective</h3><div>PARP inhibitor (PARPi) treatment is an effective option for patients with metastatic castration-resistant prostate cancer (mCRPC). There are few data on the cardiovascular and thromboembolic safety of these agents in mCRPC, as cardiovascular and thromboembolic adverse events (AEs) are uncommon. Our aim was to analyze the incidence and risk of major adverse cardiovascular events (MACEs), thromboembolic events, and hypertension with PARPi therapy in mCRPC.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We systematically searched the PubMed, EMBASE, and Cochrane databases and the American Society of Clinical Oncology and European Society of Medical Oncology meeting abstracts for clinical trials on PARPi use in mCRPC up to March 31, 2024. We analyzed the pooled incidence of all-grade and high-grade MACEs, thromboembolic events, and hypertension, and calculated risk ratios (RRs) for PARPi versus non-PARPi treatment.</div></div><div><h3>Key findings and limitations</h3><div>We included 11 phase 2 or 3 trials in our meta-analysis. Hypertension was the most common AE for both any-grade (17.2%) and high-grade (9.3%) events. In comparison to other treatments, PARPi was associated with significantly higher risk of high-grade MACEs (RR 2.03; <em>p</em> = 0.03) and thromboembolic events (RR 2.15; <em>p</em> = 0.002), especially venous thromboembolism (VTE; RR 2.13; <em>p</em> = 0.004) and pulmonary embolism (RR 3.60; <em>p</em> = 0.001). The risk of hypertension, any-grade MACEs, and thromboembolic AEs was not significantly higher, apart from VTE (RR 2.17; <em>p</em> = 0.01).</div></div><div><h3>Conclusions and clinical implications</h3><div>There is higher risk of high-grade cardiovascular and thromboembolic toxicity with PARPi use in comparison to other treatments in mCRPC, although these toxicities are rare. Clinicians should be aware of this risk, especially in a population that often has comorbidities and concomitant treatments, for correct monitoring and management of these AEs.</div></div><div><h3>Patient summary</h3><div>Drugs called PARP inhibitors are very effective in the treatment of metastatic prostate cancer that does not respond to hormone treatment. However, their use is associated with some cardiovascular adverse events, although these are rare. Our study shows that these events seem to be more frequent with PARP inhibitors than with other treatments, especially for severe grades. Doctors and patients should be aware of this risk to help in preventing, recognizing, and managing the occurrence of these rare complications.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 1-9"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}