European urology oncology最新文献

{"title":"Combination of Abiraterone Acetate, Prostate Bed Radiotherapy, and Luteinizing Hormone-releasing Hormone Agonists in Biochemically Relapsing Patients After Prostatectomy (CARLHA): A Phase 2 Clinical Trial","authors":"Loic Ah-Thiane ,&nbsp;Loic Campion ,&nbsp;Nedjla Allouache ,&nbsp;Emmanuel Meyer ,&nbsp;Pascal Pommier ,&nbsp;Nathalie Mesgouez-Nebout ,&nbsp;Anne-Agathe Serre ,&nbsp;Gilles Créhange ,&nbsp;Valentine Guimas ,&nbsp;Emmanuel Rio ,&nbsp;Paul Sargos ,&nbsp;Sylvain Ladoire ,&nbsp;Céline Mahier Ait Oukhatar ,&nbsp;Stéphane Supiot","doi":"10.1016/j.euo.2024.04.014","DOIUrl":"10.1016/j.euo.2024.04.014","url":null,"abstract":"<div><h3>Background</h3><div>The relevance of next-generation hormone therapies and circulating tumor cells (CTCs) are not elucidated in biochemical recurrence after prostatectomy.</div></div><div><h3>Objective</h3><div>To evaluate the combination of abiraterone acetate plus prednisone (AAP), prostate bed radiotherapy (PBRT), and goserelin in biochemically relapsing men after prostatectomy, and to investigate the utility of CTCs.</div></div><div><h3>Design, setting, and participants</h3><div>In this single-arm multicenter phase 2 trial, 46 biochemically relapsing men were enrolled between December 2012 and January 2019. The median follow-up was 47 mo.</div></div><div><h3>Intervention</h3><div>All patients received AAP 1000 mg daily (but 750 mg during PBRT), salvage PBRT, and goserelin.</div></div><div><h3>Outcome measurements and statistical analysis</h3><div>The primary outcome was 3-yr biochemical recurrence-free survival (bRFS) when prostate-specific antigen (PSA) levels were ≥0.2 ng/ml. The secondary outcomes included alternative bRFS (alt-bRFS) when PSA levels were ≥0.5 ng/ml and safety assessment. CTC count was assessed.</div></div><div><h3>Results and limitations</h3><div>The 3-yr bRFS and alt-bRFS were 81.5% (95% confidence interval or CI [66.4–90.3%]) and 95.6% (95% CI [83.5-98.9%]), respectively. The most common acute radiotherapy-related adverse effect (AE; all grades was pollakiuria (41.3%). The most common late AE (all grades) was urinary incontinence (15.2%). Grade 3-4 acute or late radiotherapy-related AEs were scarce. Most frequent AEs nonrelated to radiotherapy were hot flashes (76%), hypertension (63%), and hepatic cytolysis (50%, of which 20% were of grades 3-4). Of the patients, 11% had a CTC count of ≥5, which was correlated with poorer bRFS (<em>p</em> = 0.042) and alt-bRFS (<em>p</em> = 0.008). The association between CTC count and higher rates of relapse was independent of the baseline PSA level and PSA doubling time (<em>p</em> = 0.42 and <em>p</em> = 0.09, respectively). This study was nonrandomized with a limited number of patients, and few clinical events were reported.</div></div><div><h3>Conclusions</h3><div>Adding AAP to salvage radiation therapy and goserelin resulted in high bRFS and alt-bRFS. AEs remained manageable, although a close liver surveillance is advised. CTC count appears as a promising biomarker for prognosis and predicting response to treatment.</div></div><div><h3>Patient summary</h3><div>Our study was a phase 2 clinical trial that exhibited the efficacy and tolerance of a novel androgen-receptor targeting agent (abiraterone acetate plus prednisone) in patients with prostate cancer who experienced rising prostate-specific antigen after radical prostatectomy, in combination with prostate bed radiotherapy. The results also indicated the feasibility and potential value of circulating tumor cell detection, which constitutes a possible advance in managing prostate cancers.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 38-46"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140907917","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":"Effectiveness and Cost-effectiveness of Artificial Intelligence–assisted Pathology for Prostate Cancer Diagnosis in Sweden: A Microsimulation Study","authors":"Xiaoyang Du ,&nbsp;Shuang Hao ,&nbsp;Henrik Olsson ,&nbsp;Kimmo Kartasalo ,&nbsp;Nita Mulliqi ,&nbsp;Balram Rai ,&nbsp;Dominik Menges ,&nbsp;Emelie Heintz ,&nbsp;Lars Egevad ,&nbsp;Martin Eklund ,&nbsp;Mark Clements","doi":"10.1016/j.euo.2024.05.004","DOIUrl":"10.1016/j.euo.2024.05.004","url":null,"abstract":"<div><h3>Background and objective</h3><div>Image-based artificial intelligence (AI) methods have shown high accuracy in prostate cancer (PCa) detection. Their impact on patient outcomes and cost effectiveness in comparison to human pathologists remains unknown. Our aim was to evaluate the effectiveness and cost-effectiveness of AI-assisted pathology for PCa diagnosis in Sweden.</div></div><div><h3>Methods</h3><div>We modeled quadrennial prostate-specific antigen (PSA) screening for men between the ages of 50 and 74 yr over a lifetime horizon using a health care perspective. Men with PSA ≥3 ng/ml were referred for standard biopsy (SBx), for which cores were either examined via AI followed by a pathologist for AI-labeled positive cores, or a pathologist alone. The AI performance characteristics were estimated using an internal STHLM3 validation data set. Outcome measures included the number of tests, PCa incidence and mortality, overdiagnosis, quality-adjusted life years (QALYs), and the potential reduction in pathologist-evaluated biopsy cores if AI were used. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio.</div></div><div><h3>Key findings and limitations</h3><div>In comparison to a pathologist alone, the AI-assisted workflow increased the number of PSA tests, SBx procedures, and PCa deaths by ≤0.03%, and slightly reduced PCa incidence and overdiagnosis. AI would reduce the proportion of biopsy cores evaluated by a pathologist by 80%. At a cost of €10 per case, the AI-assisted workflow would cost less and result in &lt;0.001% lower QALYs in comparison to a pathologist alone. The results were sensitive to the AI cost.</div></div><div><h3>Conclusions and clinical implications</h3><div>According to our model, AI-assisted pathology would significantly decrease the workload of pathologists, would not affect patient quality of life, and would yield cost savings in Sweden when compared to a human pathologist alone.</div></div><div><h3>Patient summary</h3><div>We compared outcomes for prostate cancer patients and relevant costs for two methods of assessing prostate biopsies in Sweden: (1) artificial intelligence (AI) technology and review of positive biopsies by a human pathologist; and (2) a human pathologist alone for all biopsies. We found that addition of AI would reduce the pathology workload and save money, and would not affect patient outcomes when compared to a human pathologist alone. The results suggest that adding AI to prostate pathology in Sweden would save costs.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 80-86"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental Prostate Cancer in Patients Undergoing Surgery for Benign Prostatic Hyperplasia: A Predictive Model","authors":"Julien Anract ,&nbsp;Clément Klein ,&nbsp;Ugo Pinar ,&nbsp;Morgan Rouprêt ,&nbsp;Nicolas Barry Delongchamps ,&nbsp;Grégoire Robert","doi":"10.1016/j.euo.2024.08.009","DOIUrl":"10.1016/j.euo.2024.08.009","url":null,"abstract":"<div><h3>Background and objective</h3><div>Histopathological examination of surgical specimens for benign prostatic hyperplasia (BPH) can detect incidental prostate cancer (iPCa). The aim of our study was to develop a predictive model for iPCa diagnosis for patients for whom BPH surgery is being considered.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of medical files for patients who underwent BPH surgery in three academic centers between 2012 and 2022. Patients diagnosed with PCa before surgery were excluded. We calculated the global iPCa rate, and the clinically significant iPCa rate (grade group ≥2). Univariate and multivariable regression models were used to assess factors predictive of iPCa. The area under the receiver operating characteristic curve (AUC) was compared for each risk factor and for the global model. We used χ² automated interaction detection (CHAID) for decision tree analysis.</div></div><div><h3>Key findings and limitations</h3><div>We included 2452 patients in the analysis, of whom 247 (10.0%) had iPCa, which was clinically significant in 49/247 cases (20.2%). Multivariable analysis revealed that age and prostate-specific antigen density (PSAD) were independent predictive factors for iPCa diagnosis. The AUC for a model including age and PSAD was 0.65. CHAID analysis revealed that patients with PSAD &gt;0.1 ng/ml/cm³ had an iPCa risk of 23.4% (χ² = 52.6; <em>p</em> &lt; 0.001). For those patients, age &gt;72 yr increased the iPCa risk to 35.4% (χ² = 11.1, <em>p</em> = 0.008). Our study is mainly limited by its retrospective design.</div></div><div><h3>Conclusions and clinical implications</h3><div>Age and PSAD were independent risk factors for iPCa diagnosis. The combination of age &gt;72 yr and PSAD &gt;0.1 ng/ml/cm³ was associated with an iPCa rate of 35.4%.</div></div><div><h3>Patient summary</h3><div>We performed a study to find predictors of prostate cancer for patients undergoing surgery for benign enlargement of the prostate. Our model can identify patients at risk, and diagnose their cancer before surgery. This could avoid unnecessary or harmful procedures.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 145-151"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Refine Prostate Cancer Epidemiology: Defining New Endpoints for Effective Screening and Causal Epidemiological Studies","authors":"Olivier Cussenot ,&nbsp;Morgan Rouprêt ,&nbsp;Shahrokh F. Shariat","doi":"10.1016/j.euo.2024.12.004","DOIUrl":"10.1016/j.euo.2024.12.004","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 7-8"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893087","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":"Treatment-free Survival After First-line Therapies for Metastatic Renal Cell Carcinoma: An International Metastatic Renal Cell Carcinoma Database Consortium Analysis","authors":"Mehul Gupta ,&nbsp;Connor Wells ,&nbsp;Meredith M. Regan ,&nbsp;Wanling Xie ,&nbsp;Vishal Navani ,&nbsp;Renee Maria Saliby ,&nbsp;Naveen S. Basappa ,&nbsp;Frede Donskov ,&nbsp;Takeshi Yuasa ,&nbsp;Kosuke Takemura ,&nbsp;Christian K. Kollmannsberger ,&nbsp;Megan Crumbaker ,&nbsp;Aly-Khan A. Lalani ,&nbsp;Thomas Powles ,&nbsp;Hedyeh Ebrahimi ,&nbsp;Rana R. McKay ,&nbsp;Jae-Lyun Lee ,&nbsp;Ravindran Kanesvaran ,&nbsp;Toni K. Choueiri ,&nbsp;Daniel Y.C. Heng","doi":"10.1016/j.euo.2024.12.011","DOIUrl":"10.1016/j.euo.2024.12.011","url":null,"abstract":"<div><h3>Background and objective</h3><div>Patients receiving immune checkpoint blockade (ICB) therapy may experience periods of prolonged disease control without a need for systemic therapy. Treatment-free survival (TFS) is an important measure for this period, but no data are available for patients with metastatic renal cell carcinoma (mRCC) starting first-line agents. Our aim was to analyze TFS outcomes for patients with mRCC starting first-line therapy.</div></div><div><h3>Methods</h3><div>We analyzed data for patients with mRCC starting first-line systemic therapy with VEGFR-targeted monotherapy, an ICB + VEGFR combination, or an ICB doublet from February 1, 2014 to February 1, 2023 from the multicenter International Metastatic RCC Database Consortium (IMDC) database. We estimated 36-mo TFS as the difference in restricted mean survival time between (1) the time to first-line therapy discontinuation and (2) the time to subsequent systemic therapy initiation.</div></div><div><h3>Key findings and limitations</h3><div>The study population included 3758 patients receiving either first-line VEGFR monotherapy (<em>n</em> = 2635), an ICB + VEGFR combination (<em>n</em> = 354), or doublet ICB (<em>n</em> = 769) were included. For the IMDC favorable-risk cohort, the 36-mo TFS estimate was 3.1 mo (95% confidence interval [CI] 1.5–4.6) for the VEGFR monotherapy group and 3.7 mo (95% CI 0.2–7.2) for the ICB + VEGFR group. For the IMDC intermediate-/poor-risk cohort, TFS was 2.1 mo (95% CI 1.4–2.8) for the VEGFR monotherapy group, 3.7 mo (95% CI 1.0–6.4) for the ICB + VEGFR group, and 5.3 mo (95% CI 3.8–6.8) for ICB doublet group. Limitations include the retrospective design and an inability to quantify time spent with adverse events.</div></div><div><h3>Conclusions and clinical implications</h3><div>Our study demonstrates that patients with IMDC intermediate or poor risk treated with ICB doublet therapy experienced longer TFS than those treated with VEGFR monotherapy in the first-line setting. These results emphasize the utility of TFS as an informative endpoint and provide survival estimates to inform decision-making in mRCC.</div></div><div><h3>Patient summary</h3><div>For patients with metastatic kidney cancer, we compared the survival time free from a second treatment line for different first-line treatment options. The results show that the time free from second-line treatment was longer when first-line treatment was with a combination of two immunotherapy drugs (ipilimumab and nivolumab) in comparison to other treatment options.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 171-178"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914072","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":"Digital Twins in Urological Oncology: Precise Treatment Planning via Complex Modeling","authors":"Enrico Checcucci ,&nbsp;Christoph Oing ,&nbsp;Daniele Amparore ,&nbsp;Francesco Porpiglia ,&nbsp;Pasquale Rescigno","doi":"10.1016/j.euo.2024.10.005","DOIUrl":"10.1016/j.euo.2024.10.005","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 1-4"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497684","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":"Hall of Fame","authors":"","doi":"10.1016/S2588-9311(25)00034-3","DOIUrl":"10.1016/S2588-9311(25)00034-3","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Page viii"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378739","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":"Hematuria Cancer Risk Score with Ultrasound Informs Cystoscopy Use in Patients with Hematuria","authors":"Wei Shen Tan ,&nbsp;Amar Ahmad ,&nbsp;Yin Zhou ,&nbsp;Arjun Nathan ,&nbsp;Ayodeji Ogunbo ,&nbsp;Olayinka Gbolahan ,&nbsp;Neha Kallam ,&nbsp;Rebecca Smith ,&nbsp;Maen Khalifeh ,&nbsp;Wei Phin Tan ,&nbsp;Daniel Cohen ,&nbsp;Dimitrios Volanis ,&nbsp;Fiona M. Walter ,&nbsp;Peter Sasieni ,&nbsp;Ashish M. Kamat ,&nbsp;John D. Kelly","doi":"10.1016/j.euo.2024.05.005","DOIUrl":"10.1016/j.euo.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Hematuria is a cardinal symptom of urinary tract cancer and would require further investigations.</div></div><div><h3>Objective</h3><div>To determine the ability of renal bladder ultrasound (RBUS) with the Hematuria Cancer Risk Score (HCRS) to inform cystoscopy use in patients with hematuria.</div></div><div><h3>Design, setting, and participants</h3><div>The development cohort comprised 1984 patients with hematuria from 40 UK hospitals (DETECT 1; ClinicalTrials.gov: NCT02676180) who received RBUS. An independent validation cohort comprised 500 consecutive patients referred to secondary care for a suspicion of bladder cancer.</div></div><div><h3>Outcome measurements and statistical analysis</h3><div>Sensitivity and true negative of the HCRS and RBUS were assessed.</div></div><div><h3>Results and limitations</h3><div>A total of 134 (7%) and 36 (8%) patients in the development and validation cohorts, respectively, had a diagnosis of urinary tract cancer. Validation of the HCRS achieves good discrimination with an area under the receiver operating characteristic curve of 0.727 (95% confidence interval 0.648–0.800) in the validation cohort with sensitivity of 95% for the identification of cancer. Utilizing the cutoff of 4.500 derived from the HCRS in combination with RBUS in the development cohort, 680 (34%) patients would have been spared cystoscopy at the cost of missing a G1 Ta bladder cancer and a urinary tract cancer patient, while 117 (25%) patients would have avoided cystoscopy at the cost of missing a single patient of G1 Ta bladder cancer with sensitivity for the identification of cancer of 97% in the validation cohort.</div></div><div><h3>Conclusions</h3><div>The HCRS with RBUS offers good discriminatory ability in identifying patients who would benefit from cystoscopy, sparing selected patient cohorts from an invasive procedure.</div></div><div><h3>Patient summary</h3><div>The hematuria cancer risk score with renal bladder ultrasound allows for the triage of patients with hematuria who would benefit from visual examination of the bladder (cystoscopy). This resulted in 25% of patients safely omitting cystoscopy, which is an invasive procedure, and would lead to health care cost savings.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 87-93"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175240","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":"Consistencies in Follow-up After Radical Cystectomy for Bladder Cancer: A Framework Based on Expert Practices Collaboratively Developed by the European Association of Urology Bladder Cancer Guideline Panels","authors":"Laura S. Mertens ,&nbsp;Harman Maxim Bruins ,&nbsp;Roberto Contieri ,&nbsp;Marek Babjuk ,&nbsp;Bhavan P. Rai ,&nbsp;Albert Carrión Puig ,&nbsp;Jose Luis Dominguez Escrig ,&nbsp;Paolo Gontero ,&nbsp;Antoine G. van der Heijden ,&nbsp;Fredrik Liedberg ,&nbsp;Alberto Martini ,&nbsp;Alexandra Masson-Lecomte ,&nbsp;Richard P. Meijer ,&nbsp;Hugh Mostafid ,&nbsp;Yann Neuzillet ,&nbsp;Benjamin Pradere ,&nbsp;John Redlef ,&nbsp;Bas W.G. van Rhijn ,&nbsp;Matthieu Rouanne ,&nbsp;Morgan Rouprêt ,&nbsp;J. Alfred Witjes","doi":"10.1016/j.euo.2024.05.010","DOIUrl":"10.1016/j.euo.2024.05.010","url":null,"abstract":"<div><h3>Background and objective</h3><div>There is no standardized regimen for follow-up after radical cystectomy (RC) for bladder cancer (BC). To address this gap, we conducted a multicenter study involving urologist members from the European Association of Urology (EAU) bladder cancer guideline panels. Our objective was to identify consistent post-RC follow-up strategies and develop a practice-based framework based on expert opinion.</div></div><div><h3>Methods</h3><div>We surveyed 27 urologist members of the EAU guideline panels for non–muscle-invasive bladder cancer and muscle-invasive and metastatic bladder cancer using a pre-tested questionnaire with dichotomous responses. The survey inquired about follow-up strategies after RC and the use of risk-adapted strategies. Consistency was defined as &gt;75% affirmative responses for follow-up practices commencing 3 mo after RC. Descriptive statistics were used for analysis.</div></div><div><h3>Key findings and limitations</h3><div>We received responses from 96% of the panel members, who provided data from 21 European hospitals. Risk-adapted follow-up is used in 53% of hospitals, with uniform criteria for high-risk (at least ≥pT3 or pN+) and low-risk ([y]pT0/a/1N0) cases. In the absence of agreement for risk-based follow up, a non-risk-adapted framework for follow-up was developed. Higher conformity was observed within the initial 3 yr, followed by a decline in subsequent follow-up. Follow-up was most frequent during the first year, including patient assessments, physical examinations, and laboratory tests. Computed tomography of the chest and abdomen/pelvis was the most common imaging modality, initially at least biannually, and then annually from years 2 to 5. There was a lack of consistency for continuing follow-up beyond 10 yr after RC.</div></div><div><h3>Conclusions and clinical implications</h3><div>This practice-based post-RC follow-up framework developed by EAU bladder cancer experts may serve as a valuable guide for urologists in the absence of prospective randomized studies.</div></div><div><h3>Patient summary</h3><div>We asked urologists from the EAU bladder cancer guideline panels about their patient follow-up after surgical removal of the bladder for bladder cancer. We found that although urologists have varying approaches, there are also common follow-up practices across the panel. We created a practical follow-up framework that could be useful for urologists in their day-to-day practice.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 105-110"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436796","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":"Deintensification of Treatment for Low-grade Bladder Tumors: A Collaborative Review by the International Bladder Cancer Group (IBCG)","authors":"Roberto Contieri ,&nbsp;Mark S. Soloway ,&nbsp;Paolo Gontero ,&nbsp;Harry Herr ,&nbsp;Wassim Kassouf ,&nbsp;Laura S. Mertens ,&nbsp;Marco Moschini ,&nbsp;Michael O’Donnell ,&nbsp;Joan Palou ,&nbsp;Sarah P. Psutka ,&nbsp;Morgan Rouprêt ,&nbsp;Jeremy Y.C. Teoh ,&nbsp;Ashish M. Kamat","doi":"10.1016/j.euo.2024.08.001","DOIUrl":"10.1016/j.euo.2024.08.001","url":null,"abstract":"<div><h3>Background and objective</h3><div>Management of low-grade (LG) urothelium-confined (Ta stage) non–muscle-invasive bladder cancer (NMIBC) poses a distinct therapeutic challenge. Transurethral resection of bladder tumor (TURBT), the standard treatment, frequently has to be repeated because of high tumor recurrence rates. This places a considerable strain on both patients and health care infrastructure, underscoring the need for alternative management approaches. Herein, the IBCG (International Bladder Cancer Group), conducted a review to explore the efficacy and safety of deintensified treatment strategies for recurrent LG Ta NMIBC.</div></div><div><h3>Methods</h3><div>We conducted a collaborative review of relevant literature in the PubMed/MEDLINE and Cochrane CENTRAL databases. Our focus was on high-quality evidence, including randomized controlled trials, systematic reviews, and meta-analyses. We also reviewed guidelines published by prominent urological associations.</div></div><div><h3>Key findings and limitations</h3><div>Active surveillance, chemoablation, and office fulguration are valid treatment options for recurrent LG Ta NMIBC. These deintensified approaches offer several advantages over TURBT: lower complication rates, less morbidity, lower health care costs, and better quality of life for patients. Importantly, these benefits are achieved without compromising oncological safety.</div></div><div><h3>Conclusions and clinical implications</h3><div>Our review demonstrates that less intensive treatment strategies for recurrent LG Ta NMIBC are both feasible and valuable. The IBCG recommends use of these approaches for carefully selected patients to help lower health care costs and enhance patients’ quality of life.</div></div><div><h3>Patient summary</h3><div>We reviewed studies on less invasive management options for low-grade noninvasive bladder cancer, including active surveillance, chemical ablation, and heat treatment. Recent results confirm that these less intense treatment options can reduce the treatment burden and costs for patients and preserve their quality of life without negatively affecting cancer control outcomes.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 179-189"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105926","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}