European urology oncology最新文献

{"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}

{"title":"Reply to Alessia Cimadamore, Antonio Lopez-Beltran, Liang Cheng, and Rodolfo Montironi's Letter to the Editor re: Francesca Ambrosini, Nataniele Piol, Matteo Bauckneht, et al. Immunohistochemical Prostate-specific Membrane Antigen (PSMA) Expression Patterns of Primary Prostate Cancer Tissue as a Determining Factor for Prostate Cancer Staging with PSMA Positron Emission Tomography/Computed Tomography. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2025.02.012.","authors":"Francesca Ambrosini, Nataniele Piol, Matteo Bauckneht, Guglielmo Mantica, Carlo Terrone","doi":"10.1016/j.euo.2025.05.025","DOIUrl":"10.1016/j.euo.2025.05.025","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332727","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":"Propensity-matched Comparison of Single-port Transvesical Versus Standard Multiport Robotic Radical Prostatectomy.","authors":"Nicolas A Soputro, Carter D Mikesell, Salim K Younis, Samarpit Rai, Lin Wang, Adriana M Pedraza, Jane K Nguyen, Christopher J Weight, Jihad Kaouk","doi":"10.1016/j.euo.2025.05.023","DOIUrl":"https://doi.org/10.1016/j.euo.2025.05.023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;Introduction of the purpose-built single-port (SP) robotic platform has paved the ways for the advent of novel, regionalized surgical techniques for robot-assisted radical prostatectomy (RARP), including the SP transvesical approach. This study sought to evaluate the perioperative, oncological, and functional outcomes of transvesical SP-RARP, in comparison with the standard multiport (MP) transperitoneal technique.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review was performed on the institutional review board-approved, prospectively maintained database to identify all consecutive patients who underwent SP transvesical and MP transperitoneal RARP between 2015 and 2024. A 1:1 propensity-matched analysis was performed to ensure similar baseline clinicodemographic characteristics between the two groups, including prostate volume, preoperative prostate-specific antigen, International Society of Urological Pathology groups, and the clinical T stages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings and limitations: &lt;/strong&gt;Of the 773 patients included in our series, our propensity score-matched analysis identified 285 cases in each of the SP transvesical and MP transperitoneal cohorts. All SP procedures were completed successfully without conversion or additional ports. Despite the similar preoperative characteristics and intraoperative outcomes, the SP group was associated with a more significant history of previous abdominal surgery, as defined by the Hostile Abdomen Index of 4 (SP 37.3% vs MP 4.3%, p &lt; 0.001). In terms of the postoperative outcomes, the SP approach conferred increased rates of same-day discharges (SP 83.1% vs MP 1.1%, p &lt; 0.001), reduced opioid prescriptions (SP 6.3% vs MP 89.4%, p &lt; 0.001), and shorter postoperative Foley catheter duration (SP 4 d vs MP 7 d, p &lt; 0.001). Furthermore, transvesical SP-RARP provided significant improvements in functional outcomes, with 47% achieving immediate continence, which subsequently grew to 82.8% at 3 mo and 91.7% at 6 mo. These rates were noticeably higher than the 70.5% (p = 0.008) and 89.7% (p = 0.642) continence rates at 3 and 6 mo, respectively, for the MP approach. Both groups were otherwise similar in terms of their sexual potency outcomes, particularly with satisfactory erectile function at 12 mo being reported in 85.7% and 82.1% of the SP and MP patients, respectively (p = 0.742). Limitations of this study included the retrospective, single-institution design, which may limit the generalizability of the findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and clinical implications: &lt;/strong&gt;Herein, we demonstrated the oncological safety and efficacy of the novel SP transvesical RARP, which remained comparable with the gold-standard MP transperitoneal approach. Albeit the need for further research and long-term follow-up data, the regionalized SP transvesical approach hold a strong promise toward further improvements in patient comfort and postoperative morbidity outcomes ","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324911","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 Outcomes in Immunocompromised Patients: A Systematic Review and Meta-analysis.","authors":"Francesco Sanguedolce, Alessandro Tedde, Giuseppe Basile, Francesco Di Bello, Michael Baboudjian, Alessandro Uleri, Stefano Mancon, Daria Chernysheva, Marta Roqué Figuls, Andrea Gallioli, Angelo Territo, Morgan Rouprêt, Joan Palou, Alberto Breda","doi":"10.1016/j.euo.2025.05.021","DOIUrl":"https://doi.org/10.1016/j.euo.2025.05.021","url":null,"abstract":"<p><strong>Background and objective: </strong>The role of immunosuppression in prostate cancer (PCa) mortality is a debated topic, with a low level of evidence. This review aims to evaluate the cancer-specific mortality (CSM) and overall mortality (OM) of PCa in immunocompromised patients compared with immunocompetent individuals.</p><p><strong>Methods: </strong>A literature search was conducted in the PubMed/Medline, Embase, and Web of Science databases (up to the March 31, 2024). The analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (CRD42022361504). Data were pooled using a fixed-effect model and adjusted hazard ratios (HRs).</p><p><strong>Key findings and limitations: </strong>A total of 13 studies (n ≈ 3.4 million PCa patients) were included in the qualitative analysis; 11 studies were included in the quantitative analysis. The forest plot for CSM in immunocompromised patients failed to reach statistical significance (HR 1.04 [95% confidence interval {CI}, 0.91-1.18], p = 0.57). OM was higher in the immunocompromised cohort (HR 2.04 [95% CI, 1.94-2.15], p < 0.001). CSM for transplanted patients was comparable with that for the controls (HR 1.01 [95% CI, 0.86-1.18], p = 0.94). Patients with human immunodeficiency virus (HIV) had higher CSM rates (HR 1.83 [95% CI, 1.21-2.75], p = 0.004). Limitations included retrospective cohort studies and heterogeneity in reporting PCa stages.</p><p><strong>Conclusions and clinical implications: </strong>Transplanted patients present a CSM rate comparable with the controls, despite a higher OM rate. Other immunocompromised patients present an overall worse prognosis. The treatment algorithm should be applied by international guidelines for transplanted patients, delivering more aggressive treatments and screening strategies.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324912","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":"Stereotactic Body Radiation Therapy for Primary Renal Cancer and Genetic Markers of Response: A Phase 2 Trial.","authors":"Cheryn Song, Chang Ohk Sung, Dongsu Kim, Yunlim Kim, Hanjong Ahn, Mi-Hyun Kim, Jeong Kon Kim, Yong Mee Cho, Yeon Joo Kim, Young Seok Kim","doi":"10.1016/j.euo.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.euo.2025.06.001","url":null,"abstract":"<p><p>Controlled outcome assessment of radiotherapy for primary renal cell carcinoma (RCC) remains limited, particularly regarding its impact on ipsilateral renal function and predictors of response. We evaluated oncological and renal function outcomes of stereotactic body radiation therapy (SBRT) for RCC and identified genomic predictors of response. Our study cohort comprised 83 surgically unfit patients with cT1a RCC who were prospectively enrolled to receive SBRT of 42 Gy in three fractions between 2016 and 2022. The median tumor size was 2.3 cm and local control was achieved in 78 patients, including eight with a complete response. The 3-yr survival rates were 96% (95% confidence interval [CI] 89.8-99.9) for progression-free survival and 96% (95% CI 89.4-99.9%) for cancer-specific survival. The glomerular filtration rate of the treated kidney decreased up to 12-18 mo (-9.8 ml/min/1.73 m²) but stabilized thereafter. Transcriptome sequencing conducted on biopsy specimens from five responders and eight nonresponders showed enrichment of apical surface/junction pathways among responders, and enrichment of cell cycle, DNA repair, oxidative phosphorylation, and hypoxia pathways among nonresponders. A machine learning model based on gene expression demonstrated good predictive performance, with a cross-validated area under the receiver operating characteristic curve of 0.9. SBRT for T1a RCC was acceptable in terms of intermediate-term cancer control and preservation of renal function. Distinctive genomic profiles may aid in identifying optimal candidates pending external validation.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301480","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":"Combination Cytoreductive Surgery, Radiotherapy, or Ablation for De Novo Metastatic Prostate Cancer: The IP2-ATLANTA Internal Pilot, Phase 2, Randomised Controlled Trial.","authors":"Martin J Connor, Taimur T Shah, Johanna Sukumar, Dolan Basak, Francesca Fiorentino, Catherine Heath, Gail Horan, Nicholas Johnson, Vincent Khoo, Bijjan Khoubehi, Natalia Klimowska-Nassar, Stephen Mangar, John McGrath, Consuelo Nohpal de la Rosa, Derek Price, Bhavan Rai, Naveed Sarwar, Andrew Smith, John N Staffurth, Henry Tam, Kamal Thippu Jayaprakash, Mathias Winkler, T Dudderidge, Hashim U Ahmed","doi":"10.1016/j.euo.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.euo.2025.05.010","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;Cytoreduction of the primary prostate cancer, involved lymph nodes, and metastases may confer improved cancer control in de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC). Herein, we aimed to examine the safety and feasibility of novel cytoreductive therapies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We report the internal pilot of IP2-ATLANTA, a phase 2, multicentre, three-arm, randomised controlled trial. Patients with histologically diagnosed mHSPC of performance status 0-2 were randomly allocated (1:1:1) to the standard of care control group or one of two intervention arms, and stratified by CHAARTED-defined metastatic burden, intent to treat pelvic lymph nodes, and use of docetaxel and stereotactic ablative body radiotherapy (SABR; three or fewer metastases). The minimally invasive ablative therapy (MIAT) arm included cytoreductive prostate ablation with pelvic lymph node dissection (PLND), if involved, followed by SABR for metastases. The radical arm included treatment of the prostate with external beam radiotherapy along with pelvic lymph node radiotherapy (PLNRT), if involved, or cytoreductive radical prostatectomy with PLND, if involved, both followed by SABR for metastases. Systemic therapy was lifelong androgen deprivation therapy with docetaxel or an androgen receptor targeted agent. Repeat pretreatment prostate magnetic resonance imaging and biopsy were carried out. Pilot coprimary endpoints were complete pathological response, randomisation feasibility, and safety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings and limitations: &lt;/strong&gt;Between April 26, 2019 and February 6, 2021, 108 patients met the eligibility criteria, of whom 81 underwent randomisation (75% [81/108, 95% confidence interval {CI} 65.7-82.8]), exceeding the target recruitment rate. The median follow-up period was 25 mo (interquartile range [IQR] 20-30), age 69.0 yr (IQR 62-74), and prostate-specific antigen 80.50 ng/ml (IQR 20.25-261.78). Metastatic burden was balanced (low 51%; high 49%). Performance status was 0 in 74/81 (91%) patients, with 69/81 (85%) receiving doublet systemic therapy. Cytoreductive interventions performed were as follows: MIAT ± PLND in 23/27 (85%), prostatectomy ± PLND in 5/26 (19%), and radiotherapy ± PLNRT in 14/26 (54%). Among patients with prostate tissue for histopathological assessment, a complete pathological response occurred in 11% (6/53 [95% CI 4.3-23.0]; 11% [3/27] MIAT; 12% [3/26] radical). Grade 3 or worse adverse events were reported in 18% (5/28) of the control group, 7% (2/26) of the MIAT group, and 15% (4/26) of the patients receiving radiotherapy or prostatectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and clinical implications: &lt;/strong&gt;Randomisation to combination cytoreductive surgery, radiotherapy, and ablation was feasible. Cytoreductive treatment combinations were well tolerated and deserve further evaluation. The majority of patients still have viable residual prostate cancer after systemi","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293614","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":"Real-World Experience with a Commercial Circulating Tumor DNA Assay in Non-muscle-invasive Bladder Cancer.","authors":"Betty Wang, Laura E Davis, Christopher J Weight, Robert Abouassaly, Laura Bukavina","doi":"10.1016/j.euo.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.euo.2025.05.019","url":null,"abstract":"<p><p>Circulating tumor DNA (ctDNA) is an emerging biomarker in advanced bladder cancer, but its role in non-muscle-invasive bladder cancer (NMIBC) remains undefined. We conducted a retrospective study of 23 patients with NMIBC who underwent serial ctDNA monitoring using the commercially available Signatera assay at a single institution. ctDNA was detected in 35% of patients, with two illustrative cases highlighting its clinical utility. In one case, baseline ctDNA positivity prompted earlier reimaging that revealed locally advanced disease, leading to initiation of systemic therapy followed by planned consolidative cystectomy. In another case, ctDNA positivity following salvage intravesical therapy detected early recurrence, prompting a shift from maintenance intravesical therapy to radical cystectomy. These findings suggest that ctDNA may facilitate early detection of molecular residual disease and guide treatment decisions in NMIBC, particularly in patients with bacillus Calmette-Guérin-unresponsive disease. Prospective studies are needed to validate the role of ctDNA in risk stratification and treatment optimization for this high-risk population.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293615","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":"Clinical Trial Protocol: Impact of Testosterone Replacement Therapy on Functional and Oncological Outcomes Following Radical Prostatectomy (ENFORCE Study).","authors":"Diederik Baas, Joost van Drumpt, Lambertus Kiemeney, Jack Beck, Peter Busch Østergren, Michiel Sedelaar, Robert Hoekstra, Alexander Bellaar Spruyt, Harm van Melick, Max Bruins, Pim van Leeuwen, André Vis, Carl Wijburg, Luc Roelofs, Roderick van den Bergh, Robert van Soest, Jean-Paul van Basten, Diederik Somford","doi":"10.1016/j.euo.2025.05.024","DOIUrl":"https://doi.org/10.1016/j.euo.2025.05.024","url":null,"abstract":"<p><strong>Background and objective: </strong>Testosterone deficiency (TD) affects 18-38% of men undergoing radical prostatectomy (RP) for localised prostate cancer and may impair postoperative sexual rehabilitation. Testosterone replacement therapy (TRT) may improve sexual function and is assumed to be oncologically safe following RP, though evidence is based on nonrandomised, retrospective studies. The ENFORCE study evaluates the effects of TRT on sexual function recovery and on biochemical recurrence (BCR) following RP in men with TD.</p><p><strong>Clinical trial design and time frame: </strong>The ENFORCE study is a phase 3, multicentre, randomised, single-blind, placebo-controlled trial being conducted at ten Dutch centres. Eligible patients with TD (total testosterone <8 nmol/l, or total testosterone 8-12 nmol/l with free testosterone <225 pmol/l) and minimal preserved erectile function (Expanded Prostate Cancer Index Composite 26 [EPIC-26] sexual domain ≥40) undergoing RP are randomised to receive TRT or placebo from 6-12 wk after RP until 1 yr after RP.</p><p><strong>Endpoints: </strong>The primary endpoint is sexual function at 12 mo (EPIC-26 sexual domain). The secondary endpoints include sexual function at 6 and 24 mo, and quality of life, and hormonal and urinary function at 12 and 24 mo, assessed by the EPIC-26 and Aging Males' Symptoms questionnaires. BCR is evaluated at 12, 24, and 60 mo.</p><p><strong>Data sources and statistical analysis: </strong>Outcomes include patient-reported outcomes and laboratory results. Linear regression will assess the effect of TRT on sexual function, adjusting for baseline variability.</p><p><strong>Strengths and limitations: </strong>Strengths include the randomised design and long-term follow-up. Limitations include potential recruitment challenges due to specific inclusion criteria, limited to men with TD and minimal preserved sexual function.</p><p><strong>Funding: </strong>This work was supported by KWF Dutch Cancer Society, Besins Healthcare, and Canisius Wilhelmina Hospital Research Fund.</p><p><strong>Ethics and trial registration: </strong>This trial was approved by the Medical Research Ethics Committee Oost-Nederland (ClinicalTrials.gov, NCT04833426).</p><p><strong>Patient summary: </strong>For men with low testosterone undergoing surgery for prostate cancer (radical prostatectomy), testosterone replacement therapy (TRT) may improve recovery of sexual function and general well-being. The ENFORCE trial investigates whether TRT indeed improves sexual recovery after prostate cancer surgery and whether it can be administered safely. Although TRT is generally believed to be safe, this is based on small or potentially biased studies, and has never been investigated in a large clinical trial. Some concerns remain that TRT increases the risk of prostate cancer recurrence. The results of this trial may provide answers about the benefits and safety of TRT after prostate cancer surgery.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293613","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":"Green Perspectives in Radiation Oncology.","authors":"Jennifer Le Guevelou, David Ali, Stéphane Supiot","doi":"10.1016/j.euo.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.euo.2025.05.020","url":null,"abstract":"<p><p>The health care sector contributes 4.4% of global greenhouse gas emissions. Many countries are aiming for a carbon net-zero health care system by 2040-2050. Climate-smart practices in radiation oncology units include a progressive shift towards stereotactic body radiotherapy, the use of telemedicine, and strategies to streamline treatment workflows. Integration of geographic appropriateness in health care policies can also significantly mitigate the carbon footprint of clinical practice. Our rapid review assesses the environmental impact of climate-smart practices in radiation oncology departments, with a focus on management of prostate cancer. PATIENT SUMMARY: Health care accounts for a significant proportion of greenhouse gas emissions. A number of actions are already possible in radiotherapy departments to limit their environmental impact, such as reducing the number of radiotherapy sessions, simplifying treatment planning, and using telemedicine. These strategies should be combined with government measures to ensure that all cancer patients have access to local care centers.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283156","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":"Combined Prostate-specific Membrane Antigen Positron Emission Tomography and Multiparametric Magnetic Resonance Imaging for the Diagnosis of Clinically Significant Prostate Cancer.","authors":"Kit Mun Chow, Alvin Lee, Daniel Peh, Yu Guang Tan, Kae Jack Tay, Henry Ho, Christopher Cheng, Winnie Lam, Sue Ping Thang, Jeffrey Tuan, Law Yan Mee, Thane Ngo, Li Yan Khor, John Yuen, Renu Eapen, Nathan Lawrentschuk, Michael Hofman, Declan Murphy, Kenneth Chen","doi":"10.1016/j.euo.2025.04.017","DOIUrl":"https://doi.org/10.1016/j.euo.2025.04.017","url":null,"abstract":"<p><strong>Background and objective: </strong>More than half of men who undergo a prostate biopsy based on positive multiparametric magnetic resonance imaging (mpMRI) findings do not have clinically significant prostate cancer (csPCa). Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) may complement mpMRI to better triage men with suspected prostate cancer (PCa) and reduce the number of unnecessary biopsies performed. A diagnostic test accuracy systematic review and meta-analysis was performed to determine the diagnostic accuracy of combined imaging for csPCa detection with pairwise comparisons with mpMRI and PSMA-PET alone. A decision curve analysis (DCA) compared the strategies of performing an upfront biopsy versus combined imaging for suspected PCa patients, across varying thresholds for accepting the risk of missing a csPCa diagnosis.</p><p><strong>Methods: </strong>A search of the PubMed, Embase, Central, and Scopus databases, from inception to January 2024, was conducted. Twenty studies (2153 patients) that referenced combined imaging against histopathology were included. Bivariate meta-analyses and metaregression were performed to determine the diagnostic parameters and assess the differences between imaging modalities.</p><p><strong>Key findings and limitations: </strong>Combined imaging had sensitivity, specificity, positive predictive value (PPV), and negative predictive value of, respectively, 92% (95% confidence interval [CI] 87, 95), 64% (95% CI 48, 77), 80% (95% CI 68, 92), and 82% (95% CI 68, 97) at patient-level, and 82% (95% CI 77, 94), 85% (95% CI 77, 94), 79% (95% CI 52, 97), and 81% (95% CI 74, 98) at lesion-level analyses. Head-to-head comparisons showed significantly higher specificity and PPV than mpMRI at patient- and lesion-level analyses. On the DCA, combined imaging outperforms upfront biopsy at risk thresholds of 8% onwards. Synchronous reading of PSMA-PET/computed tomography (CT) with mpMRI was significantly more sensitive but less specific than PSMA-PET/MRI.</p><p><strong>Conclusions and clinical implications: </strong>Combined imaging improves the diagnostic accuracy of csPCa and may help better select patients for a prostate biopsy.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283155","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}