European urology oncology最新文献

{"title":"Patient-reported Outcomes in KEYLYNK-010: Pembrolizumab Plus Olaparib Versus Abiraterone or Enzalutamide for Participants with Biomarker-unselected, Previously Treated Metastatic Castration-resistant Prostate Cancer.","authors":"Niven Mehra, Emmanuel S Antonarakis, Se Hoon Park, Jeffrey C Goh, Ray McDermott, Nuria Sala Gonzalez, Peter C Fong, Richard Greil, Maria De Santis, Patricio Eduardo Yanez, Yi-Hsiu Huang, Stephen D Begbie, Felipe Rey, Gero Kramer, Hiroyoshi Suzuki, Todd L Saretsky, Sameer R Ghate, Yi Cui, Christian Hosius, Evan Y Yu","doi":"10.1016/j.euo.2025.04.018","DOIUrl":"https://doi.org/10.1016/j.euo.2025.04.018","url":null,"abstract":"<p><strong>Background and objective: </strong>Pembrolizumab plus olaparib did not significantly improve radiographic progression-free survival or overall survival versus a next-generation hormonal agent (NHA) in participants with biomarker-unselected, pretreated metastatic castration-resistant prostate cancer (mCRPC) in the phase 3 KEYLYNK-010 trial. We present prespecified patient-reported outcomes (PROs) from KEYLYNK-010.</p><p><strong>Methods: </strong>Participants were randomly assigned 2:1 to receive pembrolizumab plus olaparib or an NHA (abiraterone acetate or enzalutamide). PROs were evaluated using the Brief Pain Inventory-Short Form (BPI-SF), Functional Assessment of Cancer Therapy-Prostate Cancer (FACT-P), and EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaires. The PRO endpoints included time to pain progression (TTPP) as per BPI-SF and the least squares mean (LSM) change from baseline to week 15 in FACT-P total, BPI-SF, and EQ-5D visual analog scale (VAS) scores.</p><p><strong>Key findings and limitations: </strong>The PRO analysis population included 774 participants (pembrolizumab plus olaparib, n = 520; NHA, n = 254). The median follow-up was 18.7 (range, 6.1-31.7) mo. No meaningful differences were observed in TTPP for pembrolizumab plus olaparib versus NHA (median: 13.5 vs 12.0 mo; hazard ratio 0.95; 95% confidence interval 0.72-1.26). From baseline to week 15, no meaningful LSM differences were observed between the treatment groups in FACT-P total, BPI-SF, and EQ-5D VAS scores. Limitations include no formal hypothesis testing.</p><p><strong>Conclusions and clinical implications: </strong>No meaningful differences were observed in health-related quality of life (HRQoL) or disease-related symptom scores for pembrolizumab plus olaparib versus NHA in participants with biomarker-unselected, pretreated mCRPC. These findings suggest that pembrolizumab plus olaparib did not negatively impact HRQoL in participants with pretreated mCRPC.</p><p><strong>Clinical trial registry: </strong>NCT03834519.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674263","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":"Radiotherapy- Versus Surgery-based Treatment Strategy in High-risk Prostate Cancer.","authors":"Soumyajit Roy, Yilun Sun, James A Eastham, Martin Gleave, Christopher J D Wallis, Himisha A Beltran, Amar U Kishan, Angela Y Jia, Nicholas G Zaorsky, Himanshu Nagar, Jorge A Garcia, Eric J Small, Paul Nguyen, Gerhardt Attard, Rana R McKay, Oliver Sartor, Alejandro Berlin, Seth A Rosenthal, Susan Halabi, Randy Vince, Lee Ponsky, Scott C Morgan, Raquibul Hannan, Adam Raben, Mack Roach, Jeff M Michalski, Michael J Morris, Howard M Sandler, Daniel E Spratt","doi":"10.1016/j.euo.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.euo.2025.06.009","url":null,"abstract":"<p><strong>Background and objective: </strong>Optimal management for high-risk prostate cancer is unclear. Using individual patient data from two contemporaneous North American cooperative group phase 3 randomized controlled trials (RCTs), we compared the outcomes of high-risk prostate cancer patients treated with radiotherapy-based and radical prostatectomy (RP)-based treatment strategies.</p><p><strong>Methods: </strong>Data were collected from newly diagnosed high-risk prostate cancer patients enrolled in NRG/RTOG 0521 who received radiotherapy-based treatment (2005-2009), and those enrolled in CALGB 90203 who received surgery-based treatment (2006-2015). Patients received radiotherapy plus 24 mo of androgen deprivation therapy (ADT) ± six cycles of adjuvant docetaxel versus RP with personalized postoperative therapy ± neoadjuvant six cycles of docetaxel and 18-24 wk of ADT. The primary objective was to compare the cumulative incidence of distant metastasis considering death as a competing event using the inverse probability of treatment weighting (IPTW).</p><p><strong>Key findings and limitations: </strong>Overall, 1290 patients (radiotherapy n = 557, RP n = 733) were included with similar follow-up (median 6.4 [interquartile range {IQR}: 5.6-6.9] yr and 6.4 [IQR: 4.7-8.5] yr, respectively). Patients who received surgery had generally more favorable prognostic features and were younger relative to those who received radiotherapy. After IPTW, the cumulative incidence of distant metastasis was significantly lower in patients who underwent radiotherapy-based compared with RP-based treatment (8-yr distant metastasis: 15% [95% confidence interval {CI} 9.3-21] vs 22% [95% CI 18-26]; adjusted subdistribution hazard ratio [sHR] 0.58 [95% CI 0.42-0.81]; p = 0.001). We did not find any significant difference in the incidence of deaths after distant metastasis (adjusted sHR 0.98 [95% CI 0.61-1.58]) between the two groups.</p><p><strong>Conclusions and clinical implications: </strong>High-risk prostate cancer patients enrolled in RCTs had a significantly lower incidence of distant metastasis with a radiotherapy-based treatment strategy than with an RP-based treatment strategy, while the risk of deaths after distant metastasis was similar in the two groups.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667466","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":"Years of Life Lost in Metastatic and Locally Advanced Prostate Cancer.","authors":"Fabian Falkenbach, Quynh Chi Le, Mattia Longoni, Andrea Marmiroli, Calogero Catanzaro, Michele Nicolazzini, Federico Polverino, Zhe Tian, Jordan A Goyal, Riccardo Schiavina, Carlotta Palumbo, Gennaro Musi, Felix K H Chun, Alberto Briganti, Fred Saad, Shahrokh F Shariat, Gunhild von Amsberg, Thomas Steuber, Markus Graefen, Pierre I Karakiewicz","doi":"10.1016/j.euo.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.euo.2025.04.008","url":null,"abstract":"<p><strong>Background and objective: </strong>Prostate cancer (PCa) is the second most common cancer-specific cause of death in the USA. However, the effects of metastatic or locally advanced PCa on individual years of life lost (YLL) have not been addressed.</p><p><strong>Methods: </strong>Within the Surveillance, Epidemiology, and End Results (SEER) database 2004-2021, metastatic (cM1) and locally advanced (cT3/4, cN1) PCa patients aged 45-75 yr were included. The Monte Carlo method was used to simulate and illustrate individual survival according to the Social Security Administration life tables. Subsequently, the average YLL until the age of 75 yr between patients and simulated controls were quantified using the Kaplan-Meier method.</p><p><strong>Key findings and limitations: </strong>Overall, 21 488 and 53 506 patients with metastatic and locally advanced PCa, respectively, were included. Metastatic and locally advanced PCa patients lost, respectively, 5.76 and 0.77 yr of life compared with controls (p < 0.001). YLL due to metastatic PCa were most pronounced in younger patients (age 45-60 yr: 12.15 YLL), those diagnosed in more historic years (2004-2009: 6.37 YLL), and Black (6.86 YLL) and unmarried (6.66 YLL) individuals. Similar observations were made in patients with locally advanced PCa, although absolute YLL values were substantially lower. Limitations include the life expectancy estimation method that did not take comorbidities into account.</p><p><strong>Conclusions and clinical implications: </strong>Metastatic and locally advanced PCa resulted in 5.76 and 0.77 YLL values, respectively, relative to controls. Young, Black, and unmarried individuals were affected most. Therefore, these groups represent targets of particular interest for the early detection, treatment intensification, and psychosocial interventions.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658835","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":"Transcriptomic Analysis of Localized High-risk Prostate Cancer Improves Prognostication and Identifies Benefit from Adding Docetaxel to Definitive Radiotherapy with Androgen Suppression in the NRG Oncology/RTOG 0521 Phase 3 Trial.","authors":"Ryan M Phillips, James A Proudfoot, Elai Davicioni, Yang Liu, Daniel E Spratt, Jeff M Simko, Robert B Den, Alan Pollack, Seth A Rosenthal, A Oliver Sartor, Christopher J Sweeney, Gerhardt Attard, Leslie Longoria, Samir Patel, Michael W Straza, Jason A Efstathiou, Amit B Shah, Karen E Hoffman, Joseph P Rodgers, Howard M Sandler, Felix Y Feng, Phuoc T Tran","doi":"10.1016/j.euo.2025.04.009","DOIUrl":"10.1016/j.euo.2025.04.009","url":null,"abstract":"<p><strong>Background and objective: </strong>NRG/RTOG 0521 randomized men with high-risk localized prostate cancer (PC) to androgen suppression (AS) and definitive radiotherapy (RT) ± docetaxel-based chemotherapy (CT). The overall survival (OS) benefit with CT initially reported was lost on longer follow-up. The Decipher genomic classifier (GC) measures multiple transcripts relevant to docetaxel action. Basal/luminal differentiation portends differential response to AS and CT for high-risk localized and metastatic hormone-sensitive PC. We validated the Decipher GC in pretreatment biopsy samples for risk stratification and examined basal-luminal subtyping to predict docetaxel response.</p><p><strong>Methods: </strong>Decipher GC scores and basal-luminal cellular subtypes were generated for specimens from NRG/RTOG 0521. The primary objective was to validate the independent prognostic ability of GC for metastasis-free survival (MFS). Treatment effects in luminal proliferating (LP) and non-LP cell subtypes were examined in relation to MFS, OS, and distant metastasis (DM).</p><p><strong>Key findings and limitations: </strong>Samples were obtained from 283 patients and yielded 183 GC scores. Over median follow-up of 9.9 yr, 67 metastasis events were observed, including 34 DM events. Multivariable analysis revealed that GC was independently associated with DM (subdistribution hazard ratio 1.45) and MFS (hazard ratio 1.20). No biomarker-by-treatment interaction with GC and docetaxel was detected. The 10-yr restricted mean survival time difference in OS with CT was 13.7 mo for LP (p = 0.053) and 2.5 mo for non-LP (p = 0.63) tumors.</p><p><strong>Conclusions and clinical implications: </strong>The Decipher GC score was independently associated with DM and MFS, and LP tumors may benefit from addition of CT. Validation of these findings may allow more effective use of CT in men with localized PC. The original NRG/RTOG 0521 trial is registered on ClinicalTrials.gov as NCT00288080.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658834","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":"Assessing the Impact of Treatment Timing Protocols in Clinical Trials for Bacillus Calmette-Guérin-unresponsive Non-muscle-invasive Bladder Cancer.","authors":"Christopher Guske, Seyed Behzad Jazayeri, Christian Harrs, Nagashree Rao, Facundo Davaro, Hongzhi Xu, Logan Zemp, Alice Yu, Scott M Gilbert, Michael Poch, Philippe E Spiess, Wade Sexton, Joshua Linscott, Roger Li","doi":"10.1016/j.euo.2025.05.022","DOIUrl":"https://doi.org/10.1016/j.euo.2025.05.022","url":null,"abstract":"<p><p>Patients with bacillus Calmette-Guérin (BCG)-unresponsive (UR) non-muscle-invasive bladder cancer (NMIBC) who are ineligible for or decline radical cystectomy may pursue bladder-sparing therapy (BST). Currently, most BST trials in the BCG-UR setting mandate treatment initiation within 60-90 d of histopathologic confirmation. Given the lack of data on optimal treatment windows, we evaluated whether these time restrictions have oncologic merit. We retrospectively reviewed data for patients with BCG-UR NMIBC treated with BST at a tertiary referral center. Commonly used clinical trial cutoffs for time to treatment were assessed using Kaplan-Meier analysis. Multivariable Cox regression analysis was also performed, with time to treatment included as a continuous variable. Progression-free survival (PFS) was the primary endpoint, defined as progression to muscle-invasive disease or metastasis. Similar PFS was observed when using 30-d, 60-d, and 90-d cutoffs (all p > 0.05). These results were corroborated on multivariable analysis with adjustment for BST type. Secondary endpoints, including cystectomy-free survival and overall survival, were comparable across time-to-treatment intervals (all p > 0.05), with findings supported by multivariable analyses. These results indicate that inclusion criteria based on time to treatment can probably be expanded, which would allow more patients to participate in clinical trials by avoiding leadtime exclusion.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648965","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":"Randomized Phase 2 Trial of Presurgical Androgen Deprivation Therapy With or Without Axitinib in Prostate Cancer Presenting With Lymph Node Metastasis.","authors":"Amado J Zurita, Rebecca S Tidwell, Brian F Chapin, Deborah R Harris, Miao Zhang, Louis L Pisters, Ana Aparicio, John C Araujo, Sara Arce-Gallego, Keyi Zhu, Maria L Lozano, Lance Pagliaro, Joaquin Mateo, Christopher Logothetis, Patricia Troncoso, John W Davis","doi":"10.1016/j.euo.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.euo.2025.04.015","url":null,"abstract":"<p><strong>Background and objective: </strong>Strategies that combine systemic and locoregional therapies are increasingly used in prostate cancer (PC) with lymph node metastasis (LNM) at presentation. We investigated whether the presurgical combination of androgen deprivation therapy (ADT) and the antiangiogenic agent axitinib would be more effective than ADT alone in achieving time off systemic therapy after surgery in these patients.</p><p><strong>Methods: </strong>Patients with newly diagnosed PC with either clinically detected LNM (cTxN1M0 or cTxNxM1a) or at very high risk for subclinical LNM were treated with ADT for 2 mo and then randomized 2:1 to addition of axitinib to ADT versus continuing ADT alone for an additional 4 mo before surgery and discontinuation of systemic therapy. The primary endpoint was the rate of freedom from treatment failure in the intention-to-treat population at 1 yr postoperatively (\"success\"). Failure was defined as prostate-specific antigen >1.0 ng/ml, objective progression, or initiation of additional treatment.</p><p><strong>Key findings and limitations: </strong>Of the 73 patients accrued, 49 received axitinib + ADT and 24 received ADT alone. Of the 49 patients who had surgery on protocol, success was achieved in 26, of whom 22 received axitinib + ADT and four received ADT alone. In the node-positive group of 55 patients, the success rate was 36.8% (95% credible interval [CrI] 22.5-52.5%) for axitinib + ADT and 19.0% (95% CrI 5.7-37.9%) for ADT alone; the probability of a higher success rate with axitinib + ADT was 0.935. The median time to progression was 9.8 mo (95% confidence interval [CI] 7.6-17.4) with axitinib + ADT versus 5.7 mo (95% CI 4.0-11.3) with ADT alone (p = 0.03). Pathologic responses, time to metastatic progression, and overall survival were similar between the arms. There were no grade 4-5 toxicities or unexpected perioperative complications.</p><p><strong>Conclusions and clinical implications: </strong>In patients with newly diagnosed PC with LNM, a presurgical strategy that combines axitinib + ADT was feasible and was more likely than ADT alone to achieve significant time off treatment. However, the overall efficacy was limited, suggesting that patient selection and more effective combinations are needed.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616853","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":"Efficacy of Anti-PD-(L)1 Immunotherapy in Patients with DNA Mismatch Repair-deficient Metastatic Castration-resistant Prostate Cancer.","authors":"Sandra van Wilpe, Tarek Taha, Emily C Rothmann, Ellery Altshuler, Joe Park, Elisa M Ledet, Christian Rothermundt, Andre M Bergman, Annelieke E C A B Willemsen, Petros Tsantoulis, Jan Oldenburg, Alice Bernard-Tessier, Karim Fizazi, Debbie G J Robbrecht, Cheryl P Bruijnen, Tom van der Hulle, Emmanuel S Antonarakis, Aurelius Omlin, Henrik Grönberg, Andrew J Armstrong, Oliver Sartor, Laura A Sena, Himisha Beltran, Johann S de Bono, Niven Mehra","doi":"10.1016/j.euo.2025.04.016","DOIUrl":"https://doi.org/10.1016/j.euo.2025.04.016","url":null,"abstract":"<p><strong>Background and objective: </strong>Up to 5% of patients with metastatic castration-resistant prostate cancer (mCRPC) harbour loss-of-function alterations in mismatch repair genes (dMMR) resulting in microsatellite instability (MSI-H). Data on the efficacy of immune checkpoint inhibitors (ICIs) in dMMR mCRPC are limited, and reimbursement for these agents is not universally available.</p><p><strong>Methods: </strong>We performed an international, multicentre, retrospective study to investigate the efficacy of anti-PD-(L)1 monotherapy in dMMR mCRPC. dMMR was defined as MMR protein loss on immunohistochemistry (IHC), and/or a deleterious alteration in an MMR gene or MSI-H status according to polymerase chain reaction analysis or next-generation sequencing. The primary endpoint was progression-free survival (PFS).</p><p><strong>Key findings and limitations: </strong>Between July 2016 and July 2024, 93 patients with a median age of 70 yr (range 46-90) started anti-PD-(L)1 treatment. Patients were classified as dMMR on the basis of IHC results (n = 37, 40%), genomic alterations in MMR genes (n = 55, 59%), and/or an MSI-H phenotype (n = 64, 69%). Among evaluable patients according to Response Evaluation Criteria in Solid Tumours v1.1, the objective response rate was 46% (n = 84; 95% confidence interval [CI] 35-58%). A prostate-specific antigen decline ≥50% was observed in 60% of evaluable patients (n = 68; 95% CI 48-72%). Median PFS across the entire cohort was 7.7 mo (95% CI 5.3-12.4), with 1-yr, 2-yr, and 3-yr PFS rates of 39%, 27%, and 26%, respectively. Median overall survival was 27.0 mo (95% CI 17.7-43.5). PFS was significantly longer for patients with positive dMMR status on two or more tests than for patients with just one positive dMMR test.</p><p><strong>Conclusions and clinical implications: </strong>These data confirm the efficacy of anti-PD-(L)1 therapy in patients with dMMR mCRPC and warrant consideration of reimbursement for anti-PD-(L)1 agents in dMMR mCRPC by health authorities.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616913","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":"Predicting Active Surveillance Failure for Patients with Prostate Cancer in the Magnetic Resonance Imaging Era: A Multicentre Transatlantic Cohort Study.","authors":"Nikita Sushentsev, Irene G Li, George Xu, Anne Y Warren, Celeste Y Hsu, Madison Baxter, Dev Panchal, Christof Kastner, Sean Fernando, Ekaterina Pazukhina, Oleg Blyuss, Alexey Zaikin, Ahmed Shabaik, Anders M Dale, Michael Liss, Tristan Barrett, Tyler M Seibert","doi":"10.1016/j.euo.2025.06.012","DOIUrl":"https://doi.org/10.1016/j.euo.2025.06.012","url":null,"abstract":"<p><strong>Background and objective: </strong>Magnetic resonance imaging (MRI)-driven active surveillance (AS) is increasingly used for management of prostate cancer (PC). The aim of our study was to determine the oncological safety of contemporary MRI-driven AS and identify patients at higher risk of AS failure.</p><p><strong>Methods: </strong>This retrospective cohort study included AS patients with MRI-localised PC from three US and UK centres. The primary outcome was AS failure, which was defined as a composite of PC-specific mortality, metastasis, progression to grade group (GG) ≥4, or post-treatment biochemical recurrence. The secondary outcome was disease progression, defined as histological progression to GG 3 or progression to locally advanced disease. Hazard ratios (HRs) were estimated using multivariable Cox models, and multiplicity-adjusted log-rank tests were applied to compare event-free survival across subgroups.</p><p><strong>Key findings and limitations: </strong>The study cohort comprised 719 patients with median follow-up of 5.2 yr. Of these patients, 629 (87%) had stable disease; 36 (5%) experienced AS failure, including eight (1%) cases of metastasis and no PC-related deaths; and 54 (8%) had disease progression. Cribriform GG 2 histology was the strongest predictor of AS failure (HR 12.7, 95% confidence interval [CI] 4.8-33.6; p < 0.001), followed by tumour MRI visibility (HR 5.0, 95% CI 1.5-16.5; p = 0.009) and noncribriform GG 2 histology (HR 3.4, 95% CI 1.6-7.0; p = 0.001). Event-free survival was comparable for MRI-invisible noncribriform GG 2 and all GG 1 tumours (adjusted p > 0.05 for both outcomes). The study is limited by its retrospective design.</p><p><strong>Conclusions and clinical implications: </strong>Contemporary MRI-based AS for PC is safe for suitable patients, including men with noncribriform GG 2 tumours, particularly those that are MRI-invisible. Conversely, patients with cribriform GG 2 disease are at higher risk of AS failure, so consideration of upfront treatment is warranted for this subgroup.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616916","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 Treatment Efficacy in Metastatic Hormone-sensitive Prostate Cancer Patients with Visceral Disease: A Systematic Review and Network Meta-analysis.","authors":"Fabiano Flauto, Giuseppe Neola, Carmine Caso, Alessio Signori, Giuseppe Fornarini, Sarah Scagliarini, Sabrina Rossetti, Felice Crocetto, Francesco Grillone, Fabrizio Di Costanzo, Pasquale Rescigno, Vincenza Conteduca, Giuseppe Luigi Banna, Orazio Caffo, Marco Maruzzo, Roberto Iacovelli, Elena Castro, Roberto Bianco, Alberto Servetto, Luigi Formisano","doi":"10.1016/j.euo.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.euo.2025.06.008","url":null,"abstract":"<p><strong>Background and objective: </strong>Metastatic hormone-sensitive prostate cancer (mHSPC) patients with visceral disease (VD) represent a high-risk subgroup associated with poor prognosis. Despite the introduction of treatment intensification strategies, the optimal systemic therapy for these patients remains unclear. This network meta-analysis (NMA) aims to evaluate the efficacy of the current therapeutic combinations in terms of overall survival (OS) in the subgroup of patients with VD.</p><p><strong>Methods: </strong>A systematic review and NMA was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (PROSPERO: CRD42025642120). Phase 3 randomised controlled trials assessing systemic therapies for mHSPC were identified through the PubMed, Cochrane, and Embase databases. Only studies reporting OS outcomes for patients with VD were included. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted and analysed using a frequentist NMA framework. The risk of bias was assessed using the Confidence in Network Meta-Analysis (CINeMA) tool.</p><p><strong>Key findings and limitations: </strong>Eight phase 3 trials (7944 patients, 1189 with VD) were included. The androgen deprivation therapy (ADT) + docetaxel + darolutamide combination was the most effective regimen (HR = 0.42, 95% CI: 0.21-0.82). Among doublets, ADT + docetaxel (HR = 0.53, 95% CI: 0.30-0.93) and ADT + abiraterone (HR = 0.58, 95% CI: 0.41-0.83) showed superior efficacy to other androgen receptor pathway inhibitor-based doublet regimens, including combinations with enzalutamide, apalutamide, and darolutamide. The absence of individual patient data and the lack of efficacy data stratified by metastatic site (liver or lung involvement) were the key limitations.</p><p><strong>Conclusions and clinical implications: </strong>Treatment intensification with triplet therapy (ADT + docetaxel + darolutamide) provides the greatest OS benefit in mHSPC patients with VD. Doublet regimens incorporating chemotherapy or abiraterone remain viable alternatives. Further prospective studies are needed to refine treatment selection based on VD-specific biology and organ-specific metastatic patterns.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616914","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":"Incidence and Predictors of Acute Kidney Injury and Acute Kidney Disease After Robot-assisted Radical Prostatectomy in Prostate Cancer Patients.","authors":"Paolo Zaurito, Alexandre Calado, Leonardo Quarta, Mattia Longoni, Pietro Scilipoti, Alfonso Santangelo, Alessandro Viti, Andrea Cosenza, Simone Scuderi, Francesco Barletta, Armando Stabile, Alessio Dimonte, Marco Denti, Simone Barbieri, Antonio Esposito, Francesco Montorsi, Francesco Trevisani, Giorgio Gandaglia, Alberto Briganti","doi":"10.1016/j.euo.2025.06.011","DOIUrl":"https://doi.org/10.1016/j.euo.2025.06.011","url":null,"abstract":"<p><strong>Background and objective: </strong>Acute kidney injury (AKI) and acute kidney disease (AKD) are neglected complications of robot-assisted radical prostatectomy (RARP) that may lead to chronic kidney disease (CKD). We investigated their incidence and predictors in prostate cancer (PCa) patients undergoing RARP.</p><p><strong>Methods: </strong>Overall, 3551 consecutive patients who underwent RARP at a high-volume tertiary center were evaluated. Electronic health records were used to define AKI (within 7 d from surgery) and AKD (between 8 and 90 d after surgery) according to creatinine values. A Least Absolute Shrinkage and Selection Operator (LASSO) regression selected the final set of variables for predicting each outcome (AKI and AKD). A locally estimated scatterplot smoothing regression explored the interaction between baseline estimated glomerular filtration rate (eGFR) and the model-based probability of developing AKI or AKD.</p><p><strong>Key findings and limitations: </strong>Overall, 844 (23.8%) vs. 2073 (58.4%) vs. 634 (17.8%) patients had low- vs. intermediate- vs. high-risk PCa. The baseline eGFR was 86.8 ml/min/m² (interquartile range: 74.6-96.3). Overall, 131 (3.7%) and 134 (18.5%) patients experienced AKI and AKD after RARP, respectively, whereas 16 (2.2%) patients developed CKD stage ≥3 after surgery. Age at surgery (p = 0.042) and baseline eGFR (p = 0.002) were significant predictors of AKI and AKD, respectively. Patients with an eGFR of <80-85 ml/min/1.73 m² at baseline were at a higher risk of developing AKI/AKD.</p><p><strong>Conclusions and clinical implications: </strong>The incidence of AKI after RARP approaches 4%, and one out of five patients is at risk of AKD. Preoperative eGFR emerged as a strong predictor of AKD. Proper identification of patients at risk may lead to optimized intra- and postoperative management.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616915","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}