European urology oncology最新文献

{"title":"Associations Between Prostate Cancer and Dementia: A Nationwide Study in Sweden.","authors":"Casey Crump, Pär Stattin, James D Brooks, Jan Sundquist, Jingkai Wei, Weiva Sieh, Kristina Sundquist","doi":"10.1016/j.euo.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.euo.2025.04.001","url":null,"abstract":"<p><strong>Background and objective: </strong>Prostate cancer (PC) and dementia may commonly co-occur; yet, prior evidence for bidirectional associations is inconsistent. This study aims to determine the associations between PC and dementia in large population-based studies, which may further inform clinical care.</p><p><strong>Methods: </strong>To assess the dementia risk in men with PC, a national cohort study was conducted in 178 746 men diagnosed with PC in 1998-2017 and 1 787 460 age-matched control men in Sweden without prior dementia. Cox regression was used to estimate hazard ratios (HRs) for Alzheimer's disease (AD) and vascular dementia (VaD) through 2018. Subanalyses explored differences by PC treatment during 2005-2017. To assess the PC risk in men with dementia, case-control analyses were performed in 180 189 men with PC and 1 801 890 age-matched control men. Logistic regression was used to estimate odds ratios (ORs) for PC associated with prior AD or VaD. All analyses were adjusted for sociodemographic factors and health care utilization.</p><p><strong>Results and limitations: </strong>Among men with high-risk PC, those treated with androgen deprivation therapy (ADT) only had a higher risk of AD (HR, 1.37; 95% confidence interval [CI], 1.19-1.58) and VaD (1.51; 1.29-1.78), but not those who received other treatments. Men with low- or intermediate-risk PC had little or no increased risk of AD (HR, 1.10; 95% CI, 1.03-1.18) or VaD (0.90; 0.83-0.98). Men with AD or VaD had lower odds of high-risk PC (OR, 0.39; 95% CI, 0.35-0.45, and 0.36; 0.30-0.42, respectively) and low- or intermediate-risk PC (0.30; 0.25-0.36, and 0.30; 0.24-0.38, respectively). This study was limited to Sweden and will need replication when feasible.</p><p><strong>Conclusions: </strong>In a large national study, men with high-risk PC treated with ADT had higher risks of AD and VaD. Such men should be monitored for timely detection and treatment of dementia. In contrast, men with AD or VaD had a lower subsequent risk of PC, possibly reflecting reduced screening in these subgroups.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999897","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":"Risk of Upgrading at Final Pathology after Transperineal Versus Transrectal Magnetic Resonance Imaging-targeted Prostate Biopsies: A Post Hoc Analysis of the PERFECT Trial.","authors":"Alessandro Uleri, Eric Barret, Gaëlle Fiard, Louis Lenfant, Bernard Malavaud, Raphaële Renard-Penna, François Rozet, Jean-Baptiste Beauval, Ambroise Salin, Morgan Rouprêt, Guillaume Ploussard","doi":"10.1016/j.euo.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.018","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965183","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":"Prognostic Value of the Circulating Tumor DNA Fraction in Metastatic Castration-resistant Prostate Cancer: Results from the ProBio Platform Trial.","authors":"Alessio Crippa, Bram De Laere, Andrea Discacciati, Berit Larsson, Maria Persson, Susanne Johansson, Sanne D'hondt, Marie Hjälm-Eriksson, Linn Pettersson, Gunilla Enblad, Anders Ullén, Nicolaas Lumen, Camilla Thellenberg Karlsson, Johan Sandzén, Elin Jänes, Christophe Ghysel, Martha Olsson, Brieuc Sautois, Peter Schatteman, Wendy De Roock, Siska Van Bruwaene, Ingrida Verbiene, Jochen Darras, Els Everaert, Daan De Maeseneer, Mats Anden, Michiel Strijbos, Daisy Luyten, Ashkan Mortezavi, Jan Oldenburg, Piet Ost, Johan Lindberg, Henrik Grönberg, Martin Eklund","doi":"10.1016/j.euo.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.euo.2025.02.002","url":null,"abstract":"<p><strong>Background and objective: </strong>The aim of this study was to evaluate the prognostic value of undetectable circulating tumor DNA (ctDNA) and the dose-response relationship between ctDNA levels and survival outcomes in metastatic castration-resistant prostate cancer (mCRPC).</p><p><strong>Methods: </strong>We analyzed data for patients enrolled in the ProBio trial up to November 2022 who received an androgen receptor pathway inhibitor or taxane. We compared survival outcomes between patients with undetectable ctDNA and those with detectable ctDNA randomized to physician's choice or investigational arms. Time to no longer clinically benefiting (NLCB) and overall survival (OS) were assessed using Bayesian survival models, with results reported as survival time ratios (STRs). Dose-response relationships were estimated using spike-at-zero models.</p><p><strong>Key findings and limitations: </strong>A total of 220 patients were included, of whom 139 had detectable ctDNA (56 in the physician's choice arm, 83 in investigational arms) and 81 had undetectable ctDNA. In comparison to the undetectable ctDNA group, the physician's choice arm had 60% shorter time to NLCB (STR 0.40, 90% credible interval [CrI] 0.31-0.51) and 51% shorter OS (STR 0.49, 90% CrI 0.38-0.61). Similar results were observed in comparison to the investigational arms. Dose-response analysis revealed that the undetectable ctDNA group had twofold longer time to NLCB (STR 2.05, 90% CrI 1.66-2.57) and 1.6-fold longer OS (STR 1.63, 90% CrI 1.33-2.05) in comparison to the subgroup with a ctDNA fraction of 2.5%. Every 10-point increment in the ctDNA fraction corresponded to a 10% reduction in NLCB and OS times.</p><p><strong>Conclusions and clinical implications: </strong>Undetectable ctDNA at baseline predicts superior prognosis in mCRPC, suggesting potential for treatment de-escalation and less intensive monitoring for this subgroup of patients. This trial is registered on ClinicalTrials.gov as NCT03903835.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994606","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":"Oncological Safety and Diagnostic Yield of Percutaneous Needle-core Biopsies in Upper Tract Urothelial Carcinoma: The UPERCUT Study.","authors":"Doriane Prost, Atanas Pachev, Eric De Kerviler, Michael Baboudjian, Evanguelos Xylinas, Thomas Seisen, François Audenet, Lucas Bento, Olivier Traxer, Frédéric Panthier, Benjamin Pradere, Gauthier Marcq, Priscilla Leon, Yves Allory, Constance Thibault, Alexandre Roussel, Xavier Belin, David Chemouni, Morgan Roupret, Yann Neuzillet, François Desgrandchamps, Mathieu Roumiguie, Alexandra Masson-Lecomte","doi":"10.1016/j.euo.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.002","url":null,"abstract":"<p><strong>Background and objective: </strong>A percutaneous biopsy of suspected upper tract urothelial carcinoma (UTUC) is considered contraindicated due to potential safety concerns. This study evaluated the risk of tumor seeding along the needle track following a percutaneous needle-core biopsy for UTUC, along with diagnostic yield and oncological outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter study involving 53 patients who underwent a percutaneous biopsy for upper urinary tract urothelial carcinoma between 2012 and 2022. The primary endpoint was tumor recurrence along the biopsy needle track, assessed through a centralized review of follow-up cross-sectional imaging. The secondary endpoints included biopsy yield, histological concordance in tumor stage and grade compared with final histology in cases of nephroureterectomy, complication rates, and overall oncological outcomes.</p><p><strong>Key findings and limitations: </strong>The cohort consisted of 60% male patients with a mean age of 69 yr. At diagnosis, 32% had metastatic disease. A biopsy was performed due to diagnostic uncertainty regarding renal cell carcinoma or other diseases, distant metastases, or failed endoscopic biopsy. The median follow-up imaging time was 8.3 mo. Tumor track seeding occurred in one case (1.9%) 5 mo after the procedure. Biopsy yield was 94%, with histological concordance rates of 78% for tumor stage and 100% for grade. Complications occurred in 14.8% of cases, including two (3.7%) cases of obstructive pyelonephritis requiring endoscopic management.</p><p><strong>Conclusions and clinical implications: </strong>A percutaneous biopsy is a useful diagnostic tool for high-grade invasive upper urinary tract urothelial carcinoma, with a low risk of tumor track seeding. It provides critical histological confirmation, facilitating future research on neoadjuvant systemic therapies.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004614","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":"Outcomes of Focal Therapy for Localized Prostate Cancer: A Systematic Review and Meta-analysis of Prospective Studies.","authors":"Aleksander Ślusarczyk, Adam Gurwin, Anna Barnaś, Hamza Ismail, Marcin Miszczyk, Piotr Zapała, Mikołaj Przydacz, Wojciech Krajewski, Andrzej Antczak, Marcin Życzkowski, Łukasz Nyk, Giancarlo Marra, Juan G Rivas, Veeru Kasivisvanathan, Giorgio Gandaglia, Morgan Rouprêt, Guillaume Ploussard, Shahrokh F Shariat, Bartosz Małkiewicz, Piotr Radziszewski, Tomasz Drewa, Roman Sosnowski, Paweł Rajwa","doi":"10.1016/j.euo.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.euo.2025.02.003","url":null,"abstract":"<p><strong>Background and objective: </strong>Focal therapies (FTs) for localized prostate cancer (PCa) are recommended only within prospective registries or clinical trials. In this systematic review and meta-analysis, we aimed to synthesize data from prospective trials evaluating the efficacy and safety of FTs in patients with clinically localized PCa.</p><p><strong>Methods: </strong>Systematic searches of the PubMed, Scopus, and Web of Science databases identified prospective studies reporting oncological outcomes of FTs in treatment-naïve, clinically localized PCa patients. The primary endpoint was biopsy-proven clinically significant PCa (csPCa; International Society of Urological Pathology grade group ≥2) recurrence-free survival (csPCa RFS). The secondary endpoints included RFS, radical/systemic treatment-free survival, and adverse event (AE) rates.</p><p><strong>Key findings and limitations: </strong>Fifty studies including 4615 patients treated with FTs were analyzed; of these 50 studies, 19 were on predominantly intermediate-risk (n = 2800), 16 on mixed low-/intermediate-risk (n = 990), and 15 on low-risk (n = 825) patients. Estimates of 12- and 24-mo csPCa RFS rates were 86% (95% confidence interval [CI] 82-89%) and 81% (95% CI: 74-86%), respectively. In the intermediate-risk subgroup, the 12-mo csPCa RFS rate was 79% (95% CI: 74-83%). Five-year radical and systemic treatment-free survival was 82% (95% CI: 75-88%). The pooled incidence of grade ≥3 AEs was 3% (95% CI: 2-5%). Pad-requiring urinary incontinence increased by 3% (95% CI: 0-6%), with 11% of patients developing new erectile dysfunction (95% CI: 4-18%). The median follow-up of 21 mo (interquartile range 12-34) and the use of surrogate endpoints constitute the major limitations.</p><p><strong>Conclusions and clinical implications: </strong>The primarily short-term data from prospective studies of FT in clinically localized PCa demonstrate moderate to high cancer control with a favorable safety profile.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965007","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":"Utility of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Detecting Lymph Node Involvement in Comparison to Conventional Imaging in Patients with Bladder Cancer with Variant Histology.","authors":"Francesco Pio Bizzarri, Adam W Nelson, Alexandra J Colquhoun, Niyati Lobo","doi":"10.1016/j.euo.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.019","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995041","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":"Genetic Drivers of Quality of Life in Prostate Cancer: An Evaluation of Genetic Polymorphisms and Patient-reported Outcomes in the E3805 CHAARTED trial.","authors":"Daniel Sentana-Lledo, Xiangying Chu, Charles J Ryan, Arjun Gupta, Christopher J Sweeney, David F Jarrard, Elizabeth R Plimack, Benjamin A Gartrell, Michael A Carducci, Maha Hussain, Jorge A Garcia, David Cella, Robert S DiPaola, Mark Pomerantz, Alicia K Morgans","doi":"10.1016/j.euo.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.euo.2025.04.003","url":null,"abstract":"<p><strong>Background and objective: </strong>The rs4680 single-nucleotide polymorphism (SNP) of the COMT gene leads to a reduction in dopamine clearance, resulting in better mood and a decrease in symptoms in noncancer populations, but its influence on quality of life (QOL) during cancer treatment is undefined. We hypothesized that in comparison to wildtype (WT) COMT, the rs4680 SNP is associated with better QOL among men with metastatic hormone-sensitive prostate cancer receiving androgen deprivation therapy ± docetaxel (ADT ± D).</p><p><strong>Methods: </strong>In this post hoc analysis, we tested the association between COMT rs4680 status and Functional Assessment of Cancer Therapy-Prostate (overall QOL), Functional Assessment of Chronic Illness Therapy-Fatigue, and Brief Pain Inventory scores at baseline and at 3, 6, 9, and 12 mo using Fisher's exact test and the Wilcoxon rank-sum test. Blood samples for genotyping were collected before treatment initiation.</p><p><strong>Key findings and limitations: </strong>COMT SNP data were available for 550/790 men. Across the overall cohort, 3-mo pain severity was lower for rs4680 versus WT COMT (0.5 vs 1.25; p = 0.04). In the ADT arm, rs4680 versus WT COMT was associated with better overall QOL at 6 mo (128.9 vs 118.5; p = 0.04), less pain at 3 mo (no pain: 70.4% vs 41.5%; p = 0.01), and less pain interference at 3 mo (no interference: 76% vs 51.3%; p = 0.03), 6 mo (75% vs 48.7%; p = 0.02), and 9 mo (83.3% vs 52%; p = 0.02), with similar fatigue scores. Patients in the ADT + D arm had similar QOL regardless of COMT status.</p><p><strong>Conclusions and clinical implications: </strong>Patients with the COMT rs4680 SNP experienced less pain and better global QOL after starting ADT alone. This is the first study to show that inherited genetic traits may influence treatment tolerability in men with prostate cancer.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974420","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":"Development and Validation of the UriMee Model: A Methylation-based Diagnostic Tool for Early Diagnosis of Urothelial Carcinoma.","authors":"Ming Cao, Guoliang Yang, Tingting Zhao, Lianhua Zhang, Dandan Wang, Yang Cao, Haige Chen, Di Jin, Ruiyun Zhang, Yuping Hao, Longfei Huang, Wei Liu, Yang Zhang, Na Xue, Wei Xue","doi":"10.1016/j.euo.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.004","url":null,"abstract":"<p><strong>Background and objective: </strong>Urothelial carcinoma (UC) is a common malignancy that imposes a significant health care burden. Current diagnostic methods are limited by their invasiveness and low sensitivity, particularly for detecting low-grade tumors. Noninvasive, accurate, and reliable diagnostic tests for an early diagnosis of UC are urgently needed.</p><p><strong>Methods: </strong>UC-specific DNA methylation biomarkers were identified by combining public datasets from The Cancer Genome Atlas and Gene Expression Omnibus with a cohort from Renji Hospital (n = 50). Using the Least Absolute Shrinkage and Selection Operator regression, we developed a diagnostic model, termed the UriMee model, by selecting key biomarkers from a model cohort (n = 322) and subsequently validating it in an independent cohort (n = 131). The diagnostic performance of the assay was evaluated and compared with that of urine cytology.</p><p><strong>Key findings and limitations: </strong>At 30% threshold probability, the UriMee model demonstrated high sensitivity (92%) and specificity (92%) in distinguishing UC cases, with particularly strong performance in early-stage tumors (83% sensitivity for Ta, 93% for T1, and 100% for Tis). It significantly outperformed urine cytology, offering greater sensitivity (90% vs 25%, p < 0.001) while maintaining comparable specificity. Additionally, the model was highly effective in identifying upper tract urothelial carcinoma (UTUC), achieving sensitivity of 96%. The study's limitations include the necessity for larger multicenter studies and long-term follow-up to validate the findings and assess the test's effectiveness across diverse populations, as well as its utility in monitoring disease progression and recurrence.</p><p><strong>Conclusions: </strong>The UriMee test demonstrated high sensitivity and specificity, particularly in detecting early-stage tumors and UTUC, significantly outperforming traditional methods.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974603","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":"Challenges in Defining Clinical Complete Response to Systemic Therapy in Muscle-invasive Bladder Cancer: Insights from the EORTC STARBURST Project.","authors":"Alexandra Masson-Lecomte, Guillaume Grisay, Julien Van Damme, Verane Achard, Laura S Mertens, Thierry N Boellaard, David D'Haese, Beatrice Fournier, Anne-Sophie Govaerts, Robert Huddart, Francesco Soria, Lars Dyrskjøt, Yves Allory, Martina Pecoraro, Saskia Litiere, Bertrand Tombal, Valeria Panebianco, Yohann Loriot","doi":"10.1016/j.euo.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.euo.2025.03.005","url":null,"abstract":"<p><p>The standard of care (SOC) for treatment of muscle-invasive bladder cancer is neoadjuvant systemic treatment (NAT) with chemotherapy ± immunotherapy (pending durvalumab approval for this indication) followed by cystectomy or radiochemotherapy, regardless of the extent of any tumor response. Studies have recently begun to question the pertinence of local treatment in cases with a complete clinical response after NAT. However, such a de-escalation strategy is hampered by the poor correlation between clinical evaluation of the tumor response and final pathology results for radical cystectomy specimens. The aim of the EORTC STARBURST-1 trial is to develop and validate a multimodal assessment protocol to enhance prediction of the response to systemic treatment. This will include cystoscopy, multiparametric magnetic resonance imaging of the bladder, quantification of circulating plasma and urinary tumor DNA, and measurement of urinary biomarkers. If this protocol can be validated, it will be used in STARBURST-2 to randomize patients to either SOC or to NAT, followed by local treatment or a risk-adapted strategy according to the response to NAT. This strategy involves omitting local treatment and replacing it with intravesical or systemic treatments for complete responders, or with immediate systemic escalation in nonresponders.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992285","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":"An Online Treatment Decision Aid for Men with Low-risk Prostate Cancer Eligible for Active Surveillance and Their Partners Increases the Uptake of Active Surveillance: The Navigate Randomised Controlled Trial.","authors":"Penelope Schofield, Stephen Quinn, Natalie Richards, Alan White, Fiona White, Mark Frydenberg, Suzanne Chambers, Louisa G Gordon, Robert Alexander 'Frank' Gardiner, Declan G Murphy, Matthew J Roberts, John Yaxley, Nathan Lawrentschuk, Kevin Chu, Jeremy Millar, Jeremy Grummet, Ilona Juraskova","doi":"10.1016/j.euo.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.euo.2025.02.004","url":null,"abstract":"<p><strong>Background and objective: </strong>Evidence suggests that curative treatment for low-risk prostate cancer (LRPC) has no survival benefits over active surveillance (AS); thus, treatment choice becomes a value-sensitive decision. Decision aids (DAs) have the potential to facilitate this process, yet no DA has been tailored to the Australian health care system or population. This study aims to evaluate the impact of an online DA (Navigate) on the uptake of AS, quality of life, and decision-making in Australia.</p><p><strong>Methods: </strong>This parallel-group, prospective, randomised controlled trial recruited men (from May 2017 to May 2021) from participating cancer centres, via self-referral, or via clinician referral. The inclusion criteria were the following: a recent LRPC diagnosis, no decision on treatment, and clinical suitability for AS. Partners could also enrol. Assessments were undertaken at baseline (before decision) and after baseline (1, 2, and 6 mo). Participants were randomised 1:1 to Navigate (online DA, intervention) or a national prostate cancer website (usual care), stratified by the site/recruitment method. Partners were allocated to the group matching their respective partners. The primary outcome was self-reported uptake of AS for first-line treatment at 1 mo. The secondary outcomes included decision-making preparedness; decisional conflict, regret, and satisfaction; illness communication; and prostate cancer-specific quality of life. Intention-to-treat analyses were conducted.</p><p><strong>Key findings and limitations: </strong>Of the 619 patients referred, those eligible (n = 302) were randomised to either Navigate (n = 153) or usual care (n = 149), with no significant between-group differences at baseline. The proportion of men self-reporting AS versus another treatment was 90.6% (Navigate) versus 79.0% (usual care; p = 0.008). Navigate participants also reported greater decision-making preparedness (p < 0.001). Partners were allocated to Navigate (n = 70) or usual care (n = 49); no significant between-group differences were found. Longer-term outcomes were not measured.</p><p><strong>Conclusions and clinical implications: </strong>Providing men with an online DA resulted in higher uptake of AS for LRPC than standard resources and in increased decision-making preparedness. By increasing the uptake of AS, DAs may help reduce treatment-related morbidity. Implementation research assessing the possibility of integrating Navigate into standard care is needed.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993803","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}