European urology oncology最新文献

{"title":"Do We Need Early Detection of Grade Group 2 Prostate Cancer in a Screening Program for Young Men? Results from the PROBASE Screening Trial.","authors":"Peter Albers, Agne Krilaviciute, Petra Seibold, Maxime de Vrieze, Jale Lakes, Markus A Kuczyk, Nina N Harke, Jürgen Debus, Christoph A Grott, Jürgen E Gschwend, Kathleen Herkommer, Victoria A Soehne, Axel Benner, Glen Kristiansen, Boris Hadaschik, Christian Arsov, Gerald Antoch, Lars Schimmöller, Frederik L Giesel, Marcus R Makowski, Frank Wacker, Heinz-Peter Schlemmer, Rudolf Kaaks, Nikolaus Becker","doi":"10.1016/j.euo.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.euo.2025.06.007","url":null,"abstract":"<p><p>In general, low-risk and favorable intermediate-risk prostate cancers (PCs; International Society of Urological Pathology grade group [GG] 1 and GG 2) are slow-growing cancers with low metastatic potential. Active surveillance is recommended for GG 1 PC and can be recommended for GG 2 PC in the absence of adverse pathological parameters. Therefore, the question arises as to when low-grade PC should be detected in a screening setting. We conducted an analysis of the group with intermediate prostate-specific antigen (PSA) risk (1.5-2.99 ng/ml) from the PROBASE screening trial for young men (starting age 45 yr) and evaluated 159 biopsies performed for confirmed PSA ≥3 ng/ml in the first two biennial screening rounds. Of these biopsies, 37% were positive, with 78% (46/59) showing GG 1 or GG 2 disease. Only 0.8% of men with intermediate risk (13 of 1661 men screened) had GG 3-5 PC and would have experienced a delay in diagnosis of between 1 and 3 yr if screening were performed at 5-yr intervals. These results suggest that the screening interval could be extended from 2 yr to 5 yr for men aged 45 yr at intermediate risk, similar to the interval for men at low risk (PSA <1.5 ng/ml). This would reduce unnecessary testing and overdiagnosis in nearly 10% of the screening population aged 45 yr.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Natural History of Confirmed Grade Group 1 Prostate Cancer Managed with Active Surveillance in the Modern Era.","authors":"Kevin Shee, Jonathan J Song, Janet E Cowan, Lufan Wang, James Nie, Meera Chappidi, Samuel L Washington, Hao G Nguyen, Matthew R Cooperberg, Katsuto Shinohara, Peter R Carroll","doi":"10.1016/j.euo.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.euo.2025.06.005","url":null,"abstract":"<p><strong>Background and objective: </strong>Grade group 1 (GG1, Gleason 3 + 3) prostate cancer (PCa) is considered low risk but can upgrade, and is managed with active surveillance (AS). Amidst recent controversy of whether GG1 PCa should be called cancer, we determined the nature of progression of GG1 disease in a modern AS cohort with multiparametric magnetic resonance imaging (mpMRI) and genomic testing.</p><p><strong>Methods: </strong>The Urologic Outcomes Database at the University of California San Francisco was queried for men with confirmed GG1 PCa. The primary outcome was biopsy upgrade (≥GG2, Gleason ≥3 + 4). The secondary outcomes included major upgrade (≥GG3, Gleason ≥4 + 3), metastasis, mortality, PCa-specific mortality, and active treatment after upgrade. Life table estimates, Kaplan-Meier analyses, and multivariable Cox proportional hazards regression models were performed.</p><p><strong>Key findings and limitations: </strong>A total of 1429 men met the inclusion criteria. The 10-yr rates of upgrade and major upgrade were 62% and 19%, respectively. The 10-yr rates of metastasis, mortality, and PCa-specific mortality were 1.9%, 3.4%, and 0.1%, respectively. The 5-yr rate of active treatment after upgrade was 73%. On multivariable regression analyses, increasing age, percentage of positive cores, and prostate-specific antigen density, but not positive mpMRI, change in mpMRI, or high-risk genomics, were significantly associated with the risk of upgrade. Upgrade to ≥GG3 was the only factor associated with advancement to active treatment.</p><p><strong>Conclusions and clinical implications: </strong>Men with confirmed GG1 PCa on AS have high rates of upgrade, and low rates of metastasis and mortality at 10 yr, confirming the appropriateness of AS. A high-risk genomic score, and initial positive mpMRI or change in mpMRI were not associated with upgrade outcomes, requiring further optimization.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575150","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":"Radium-223 in Men with Metastatic Castration-resistant Prostate Cancer: A Systematic Literature Review of Real-world Outcomes in Observational Studies.","authors":"Michaela Lunan-Taylor, Amit D Raval, Nguyen Thi Nhan Phan, Matthew J Korn, Vanessa Quintero, Rana R McKay","doi":"10.1016/j.euo.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.euo.2025.06.002","url":null,"abstract":"<p><strong>Background and objective: </strong>Radium-223 (Ra-223) has been approved since 2013 for men with metastatic castration-resistant prostate cancer (mCRPC) with bone metastases. Since then, the treatment landscape has changed dramatically, and a comprehensive understanding of the real-world outcomes of Ra-223 use is needed. This systematic literature review summarizes the real-world effectiveness and safety of Ra-223 in men with mCRPC.</p><p><strong>Methods: </strong>Electronic databases were searched systematically for real-world observational studies from the past 10 yr examining the outcomes in men with mCRPC treated with Ra-223.</p><p><strong>Key findings and limitations: </strong>Forty-eight studies including 15 368 men with mCRPC met the inclusion criteria. Most studies were from Europe (n = 22) and North America (n = 18; sample size range, 104-1628). Studies in Europe and North America reported ≥60% and 55% completing five or more cycles of Ra-223, respectively. First-line therapy, no prior chemotherapy or immunotherapy, and high hemoglobin and neutrophil levels were the key factors associated with completing five or more cycles. The median real-world overall survival varied (11-24 mo), with one exception. Completion of five or more cycles was associated with a two- to five-fold increase in the median real-world overall survival. Of 14 studies reporting fractures, incidence was <10% in most studies (n = 12), with trends toward lower rates using bone health agents (BHAs).</p><p><strong>Conclusions and clinical implications: </strong>This is the most comprehensive review of the effectiveness and safety of the use of Ra-223 in a population after the adoption of androgen-receptor pathway inhibitors. The findings highlight the survival benefits of the early use of Ra-223 with completion of five or more cycles, a favorable safety profile, and low rates of fracture when guideline-recommended BHAs are used.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511758","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":"Radiation Therapy in the Management of Muscle-invasive Bladder Cancer with Carcinoma in Situ: Still a No Go?","authors":"Constance Huck, Vérane Achard, Jason Efstathiou, Julien Van Damme, Alexandre R Zlotta, Evanguelos Xylinas, Ananya Choudhury, Morgan Rouprêt, Bertrand Tombal, Paul Sargos","doi":"10.1016/j.euo.2025.05.028","DOIUrl":"https://doi.org/10.1016/j.euo.2025.05.028","url":null,"abstract":"<p><strong>Background and objective: </strong>This narrative review explores the impact of carcinoma in situ (CIS) on outcomes in muscle-invasive bladder cancer (MIBC) after trimodal therapy (TMT) comprising transurethral resection of bladder tumor, a radiosensitizing agent and radiation therapy (RT). There is limited and inconsistent evidence on the effect of CIS, often considered a contraindication to TMT, on treatment efficacy.</p><p><strong>Methods: </strong>We reviewed studies evaluating the influence of TMT and RT alone on clinical outcomes in CIS-associated MIBC. Endpoints evaluated included complete response (CR) rates, overall survival (OS), disease-specific survival (DSS), and RT protocol variations, such as fractionation schedules, total doses, and the use of image-guided RT.</p><p><strong>Key findings and limitations: </strong>Evidence from studies on RT alone is inconsistent, often because of outdated regimens and inadequate CIS evaluation. Retrospective TMT studies suggest that CIS does not significantly affect CR rates, although its impact on OS and DSS remains uncertain, particularly with suboptimal RT protocols. Emerging evidence supports continuous and moderately hypofractionated RT combined with image-guided RT as potential strategies to improve outcomes. Standardized definitions of extensive CIS and better patient selection are critical for optimizing bladder preservation strategies.</p><p><strong>Conclusions and clinical implications: </strong>CIS presents significant challenges for TMT in MIBC, necessitating precise assessment, advanced RT techniques, and multidisciplinary collaboration. Novel therapies, including immunotherapy and intravesical agents, may further improve outcomes. Research into standardized protocols is essential to optimize treatment strategies.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505281","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":"PERSEUS1: An Open-label, Investigator-initiated, Single arm, Phase 2 Trial Testing the Efficacy of Pembrolizumab in Patients with Metastatic Castration-resistant Prostate Cancer with Mismatch Repair Deficiency and Other Immune-sensitive Molecular Subtypes.","authors":"Pasquale Rescigno, Maria Dolores Fenor de la Maza, Holly Tovey, Guillermo Villacampa, Fay Cafferty, Stephanie Burnett, Morgaine Stiles, Bora Gurel, Nina Tunariu, Suzanne Carreira, Ines Figueiredo, Nick Beije, Penny Flohr, Emma Hall, Alice Hill, Muneeb Mahmud, Carla Perna, Ajit Sarvadikar, Adam Sharp, Katarzyna Abramovich, Caterina Aversa, Claudia Bertran, Diletta Bianchini, Juliet Carmichael, Khobe Chandran, Mateus Crespo, Emily Cross, Andra Curcean, Ana Ferreira, Rafael Grochot, Christina Guo, Lucy Hamilton, Lesley Harden, Joanne Hunt, Ossian Longoria, Lorena Martos, Susana Miranda, Ruth Riisnaes, Sheena Vadgama, Daniel Westaby, Julie Wilkinson, Christina Yap, Johann S de Bono","doi":"10.1016/j.euo.2025.04.025","DOIUrl":"https://doi.org/10.1016/j.euo.2025.04.025","url":null,"abstract":"<p><strong>Background and objective: </strong>Some metastatic castration-resistant prostate cancers (mCRPCs) present mismatch repair deficiency (MMRd) and other molecular subtypes potentially sensitive to immune checkpoint inhibitors (ICIs). The PERSEUS1 trial evaluated the response to pembrolizumab in these subtypes.</p><p><strong>Methods: </strong>This open-label, investigator-initiated, single-arm, phase 2 trial used a two-stage Simon minimax design. Results from stage 1 are presented here. Tumour biopsies from patients with mCRPC progressing on standard therapies were analysed via targeted next-generation sequencing and immunohistochemistry. Patients with MMRd and/or other molecular subtypes associated with ICI sensitivity were treated with pembrolizumab until disease progression or unacceptable toxicity. The primary outcome was response by 24 wk using a composite of radiological objective response; confirmed decrease in prostate-specific antigen ≥50%; or conversion of circulating tumour cell count. The hypothesised desirable response rate was 40%, with 20% deemed unacceptable; >5/24 responses were required for progression to stage 2.</p><p><strong>Key findings and limitations: </strong>In total, 25 patients from two centres received a median of 6 cycles (range 2-13) of pembrolizumab, with a response observed in seven (28.0%, 95% confidence interval 12.1-49.4%). Median progression-free survival was 2.8 mo and median overall survival was 16.0 mo. Nineteen patients (76%) experienced treatment-related adverse events, including three (12%) grade 3-4 events. There were no treatment-related deaths. While the prespecified threshold for futility was not met, slow accrual meant the study did not progress to stage 2.</p><p><strong>Conclusions and clinical implications: </strong>Pembrolizumab showed antitumour activity against MMRd and/or other mCRPC molecular subtypes, with a manageable toxicity profile. Genomic and molecular stratification and further translational research are needed to refine patient selection for this therapy in the mCRPC setting.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505280","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":"Re: Gerhardt Attard, Neeraj Agarwal, Julie Graff, et al. Niraparib plus Abiraterone Acetate and Prednisone for HRR-mutated Metastatic Castration-sensitive Prostate Cancer: Results from the AMPLITUDE Phase 3 Trial. J Clin Oncol 2025;43(17 Suppl):LBA5006.","authors":"Giuseppe Di Lorenzo, Francesco Montorsi, Carlo Buonerba","doi":"10.1016/j.euo.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.euo.2025.06.006","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505282","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":"Assessment of the Reporting and Incidence of Prostate Cancer Unconventional Histologies in Tertiary Referral Institutions: An Under-reported but Exploding Phenomenon?","authors":"Giancarlo Marra, Geert J L H van Leenders, Guglielmo David, Marco Oderda, Kirsti Aas, Isabel Heidegger, Fabio Zattoni, Bartosz Małkiewicz, August Sigle, Guglielmo Mantica, Juan Gómez Rivas, Igor Tsaur, Timo F W Soeterik, Rossella Nicoletti, Erika Palagonia, Agostino Mattei, Luca Afferi, Yannic Raskin, Peter Chiu, Alberto Briganti, Francesco Montorsi, Paolo Gontero, Giorgio Gandaglia","doi":"10.1016/j.euo.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.euo.2025.05.001","url":null,"abstract":"<p><p>Prostate cancer (PCa) with unconventional histologies (UHs) is not infrequent and may be associated with different prognosis compared with conventional PCa depending on the type, subtype, or pattern considered. A recent World Health Organization update recommends UHs to be reported on biopsy and final pathology. Our study aimed to assess the incidence and reporting attitudes of PCa UHs at tertiary referral institutions. Overall, 22 and 11 centers provided data on internal pathological guidelines and/or UH incidence, respectively. A comprehensive list of UHs was reported by pathologists only in <50% of the centers. Of note, ductal, intraductal, cribriform, and sarcomatoid UHs were consistently reported in ≥85% of the centers. The incidence of UHs was 373 on 15 605 biopsies (2.4%) and 737 on 14 945 (4.9%) final pathology specimens. However, UH incidence at final pathology increased from 0.7% in 2010 to 19% in 2023, while it remained stable on biopsy (1.5% in 2010 and 2.1% in 2023). The most frequent UH was cribriform (64%), followed by ductal (10%) and intraductal (9%) PCa. In conclusion, UHs are not infrequent and their recognition is increasing. However, pathological reporting is not well standardized, and prostate biopsies likely underestimate UHs.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505279","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":"Epidemiology of High-risk Biochemical Recurrence After Primary Prostate Cancer Treatment.","authors":"Ugo Giovanni Falagario, Francesco Pellegrino, Lars Björnebo, Ahmad Abbadi, Alberto Martini, Alexander Valdman, Vincenza Conteduca, Giuseppe Carrieri, Giorgio Gandaglia, Alberto Briganti, Francesco Montorsi, Thorgerdur Palsdottir, Martin Eklund, Tobias Nordström, Henrik Grönberg, Markus Aly, Ash Tewari, Olof Akre, Anna Lantz, Peter Wiklund","doi":"10.1016/j.euo.2025.05.026","DOIUrl":"10.1016/j.euo.2025.05.026","url":null,"abstract":"<p><strong>Background and objective: </strong>Biochemical recurrence (BCR) risk stratification guides treatment decisions after primary prostate cancer (PCa) treatment. We evaluated high-risk BCR (HR-BCR) definitions after radical prostatectomy (RP) or radiotherapy (RT) and their association with PCa-specific mortality (PCSM).</p><p><strong>Methods: </strong>A population-based cohort study including 17 753 men treated with RP (n = 12 010) or RT (n = 5743) for localized PCa in Stockholm County between 2003 and 2021 was conducted. We assessed the cumulative incidence of any BCR (RP: prostate-specific antigen [PSA] ≥0.2; RT: PSA ≥nadir + 2), European Association of Urology (EAU) HR-BCR (PSA doubling time ≤1 yr or pathological International Society of Urological Pathology (ISUP) grade group 4-5 after RP; time to BCR ≤18 mo or biopsy ISUP grade group 4-5 after RT), and EMBARK HR-BCR (PSA doubling time ≤9 mo and PSA >1 ng/ml after RP or PSA ≥nadir + 2 ng/ml after RT). PCSM after HR-BCR was estimated using the competing risk method.</p><p><strong>Key findings and limitations: </strong>The 10-yr incidence of HR-BCR was 10% (95% confidence interval [CI]: 9-11) for EAU HR-BCR and 4% (95% CI: 3-4) for EMBARK HR-BCR after RP, and 10% (95% CI: 9-11) for both definitions after RT. Patients meeting the EMBARK criteria had the highest PCSM (RP: 30%, 95% CI: 24-37; RT: 50%, 95% CI: 45-56). Up to 50% of RP and 31% of RT patients with BCR did not progress to HR-BCR and had lower PCSM.</p><p><strong>Conclusions and clinical implications: </strong>HR-BCR incidence varies by definition and treatment. The EMBARK criteria identify a smaller subset with the highest PCSM risk. Many patients with BCR never develop HR-BCR. Refining BCR definitions with PSA kinetics and imaging may optimize risk stratification, balancing therapeutic efficacy and overtreatment.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368742","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":"Prostate Cancer Testing Between Screening Rounds: Evidence from the STHLM3-MRI Trial.","authors":"Daniela Skalt, Ting Chen, Ahmad Abbadi, Anna Lantz, Andrea Discacciati, Martin Eklund, Mark Clements, Tobias Nordström, Shuang Hao","doi":"10.1016/j.euo.2025.05.015","DOIUrl":"10.1016/j.euo.2025.05.015","url":null,"abstract":"<p><strong>Background and objective: </strong>The STHLM3-MRI screening-by-invitation trial found that magnetic resonance imaging (MRI)-based screening for prostate cancer (PCa) improved early detection in comparison to systematic biopsy. The aim of the present study was to describe testing and PCa incidence between screening rounds of the STHLM3-MRI trial.</p><p><strong>Methods: </strong>The study population comprised men aged 50-74 yr in the MRI (experimental) arm of the STHLM3-MRI trial without a PCa diagnosis in the first round. We defined three risk groups: low risk (baseline prostate-specific antigen [PSA] <1.5 ng/ml; not invited to the second round after 2-3 yr); non-elevated risk (1.5 ≤PSA <3 ng/ml and Stockholm3 score <11%); and elevated risk (PSA ≥3 ng/ml or Stockholm3 score ≥11%). Interval events included PSA tests, MRI examinations, biopsies, and PCa detection.</p><p><strong>Key findings and limitations: </strong>In the study population of 7256 men, 33% had at least one PSA test, 2.2% had an MRI examination, 0.8% had a biopsy, 0.3% had a PCa diagnosis, and 0.2% (n = 17) had International Society of Urological Pathology grade group ≥2 PCa between screening rounds. Stratified by risk, 27%, 40%, and 54% of men with low risk (n = 5009), non-elevated risk (n = 1200), and elevated risk (n = 1047), respectively, had a PSA test. The PCa detection rate was low but increased with risk level, at 0.1% for low risk, 0.3% for non-elevated risk, and 1.4% for elevated risk. These results are specific to Sweden and depend on the interval length between screening rounds.</p><p><strong>Conclusions and clinical implications: </strong>We observed a substantial testing rate of 33% between STHLM3-MRI screening rounds, but few PCa cases were detected among men with lower risk. Most cancers were diagnosed in the elevated-risk group. A reduction in opportunistic testing in lower-risk groups will be crucial for optimising the benefits of future screening programmes.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340071","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":"Pooled Analysis of the SOLAR and SATURN Clinical Trials Comparing Progression of Synchronous Versus Metachronous Prostate-specific Membrane Antigen-defined Oligometastatic Prostate Cancer Following Systemic and Tumor-directed Therapy.","authors":"Jesus E Juarez Casillas, John Nikitas, Matthew B Rettig, Robert E Reiter, Alan Lee, Michael L Steinberg, Luca Valle, Tahmineh R Kalbasi, Jeremie Calais, Johannes Czernin, Michelle A Eala, Sonny Tsai, Nathanael Kane, Abhishek A Solanki, Rachael Sexton, Sai Duriseti, Gholam R Berenji, William J Aronson, Isla P Garraway, Michael G Chang, Robert Kwon, Steve P Lee, Nicholas G Nickols, Amar U Kishan","doi":"10.1016/j.euo.2025.05.027","DOIUrl":"10.1016/j.euo.2025.05.027","url":null,"abstract":"<p><p>Multimodal strategies combining primary and metastasis-directed therapy (MDT) with short-term intensified systemic therapy may improve outcomes in oligometastatic castrate-sensitive prostate cancer (omCSPC) while minimizing long-term toxicity. This post hoc analysis of two prospective phase 2 trials, SOLAR (NCT03298087) and SATURN (NCT03902951), evaluated oncologic outcomes in prostate-specific membrane antigen positron emission tomography-defined synchronous and metachronous omCSPC (≤5 M1a-b lesions), respectively. All patients received 6 mo of intensified systemic therapy (leuprolide, abiraterone acetate with prednisone, and apalutamide) and stereotactic body radiotherapy to oligometastases. SOLAR patients were treatment-naïve and also underwent radical prostatectomy (RP) or definitive prostate-directed radiotherapy (dRT). SATURN enrolled patients with post-RP recurrences: among the 26 patients who completed protocol therapy, 12 (46%) had prior androgen deprivation therapy (ADT), six (23%) had prior MDT, and 17 (65%) had one to three prior recurrences. The primary endpoint for both studies was prostate-specific antigen (PSA) response, defined as <0.05 ng/ml after RP or <2 ng/ml after dRT at 6 mo after testosterone recovery (≥150 ng/dl). Secondary endpoints included progression-free survival (PFS) and eugonadal PFS starting from the time of testosterone recovery. Progression was determined biochemically using PSA thresholds of ≥0.05 ng/ml for post-RP and ≥2 ng/ml for post-dRT patients. Among 50 patients (24 synchronous and 26 metachronous), the synchronous omCSPC group had a significantly higher PSA response rate (83% vs 50%; p = 0.018) and significantly longer PFS and eugonadal PFS (p < 0.05). The metachronous subgroup with prior ADT had worse outcomes, suggesting increasing resistance with repeated systemic therapy.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336447","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}