European urology oncology最新文献

{"title":"Risk-based Prostate-specific Antigen Monitoring Reduces Follow-up Burden After Radical Prostatectomy.","authors":"Leonor Jane Paulino Pereira, Roderick C N van den Bergh, Michiel J P M Sedelaar, Berdine L Heesterman, Katja K H Aben, Lambertus Kiemeney, Inge van Oort, Harm H E van Melick","doi":"10.1016/j.euo.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.euo.2025.02.013","url":null,"abstract":"<p><strong>Background and objective: </strong>The European Association of Urology (EAU)-recommended follow-up schedule after radical prostatectomy (RP)-biannual prostate-specific antigen (PSA) testing for 3 yr, followed by annual testing-does not take into account variations in biochemical recurrence (BCR) risk. Therefore, we propose an optimised, risk-adapted PSA monitoring schedule for the first 5 yr after RP, stratifying patients into BCR-based risk groups, to reduce unnecessary PSA testing without compromising BCR detection rates.</p><p><strong>Methods: </strong>Men were diagnosed with localised prostate cancer in 2015-2016, who underwent primary RP, with undetectable PSA levels <6 wk after RP, as identified in the nationwide Netherlands Cancer Registry. The outcome measures included BCR-free survival (BCR defined as PSA ≥0.1 ng/ml). Cox proportional hazards models were used to identify three risk groups; Kaplan-Meier curves illustrated BCR-free survival rates. The average BCR risk per PSA follow-up consultation in the current EAU schedule was used as a threshold to determine consultations needed in the revised risk-based schedule.</p><p><strong>Key findings and limitations: </strong>In total, 1043 patients were included in the study. Significant predictors for BCR included PSA at diagnosis, pT stage, pN stage, pathological International Society of Urological Pathology grade group, and positive surgical margins. Stratification (based on hazard ratio) resulted in 43% low-risk (15% BCR), 42% intermediate-risk (36% BCR), and 15% high-risk (72% BCR) patients. The overall 5-yr BCR-free survival rate was 62% (95% confidence interval 58-66). Low-risk patients required four, intermediate-risk patients required eight, and high-risk patients required ten consultations in the revised schedule over the first 5 yr, reducing 18% of consultations compared with the EAU schedule, with 3% delayed BCR detection. Study limitations include a potential bias due to informative censoring.</p><p><strong>Conclusions and clinical implications: </strong>This optimised risk-adapted PSA monitoring schedule following RP reduced the number of unnecessary PSA tests, particularly in low-risk patients, without compromising BCR detection rates.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992286","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":"Variation in Prostate Magnetic Resonance Imaging Performance: Data from the Prostate Biopsy Collaborative Group.","authors":"Sunny B Nalavenkata, Emily Vertosick, Alberto Briganti, Hashim Ahmed, David Eldred-Evans, Steven Gordon, Holly Raghallaigh, Christian Gratzke, Michael O'Callaghan, Michael Liss, Peter Chiu, Michael Müntener, John Yaxley, Cedric Poyet, Matthias Jahnen, Ants Toi, Sangeet Ghai, Daniel Margolis, Donna Ankerst, Behfar Ehdaie, Manish I Patel, Andrew J Vickers","doi":"10.1016/j.euo.2025.02.007","DOIUrl":"10.1016/j.euo.2025.02.007","url":null,"abstract":"<p><strong>Background and objective: </strong>The quality and reporting of prostate magnetic resonance imaging (MRI) are operator dependent, leading to variations in estimates such as positive predictive value across sites. This impacts patient counseling, risk modeling, and risk calculators. This study assessed variation in Prostate Imaging Reporting and Data System (PI-RADS) score classification and subsequent probability of grade group (GG) ≥2 + prostate cancer.</p><p><strong>Methods: </strong>Data from the Prostate Biopsy Collaborative Group, including multiple sites in North America, Europe, and Asia Pacific, were analyzed. Patients underwent multiparametric MRI (mpMRI) of the prostate followed by prostate biopsy during the years 2010-2023. Only those with MRI-targeted biopsy and PI-RADS score ≥3 were included. The risk of being assigned PI-RADS 4 or 5 and risk of GG ≥2 disease for these scores were estimated using logistic regression.</p><p><strong>Key findings and limitations: </strong>The cohort included 7325 biopsies from 7320 unique patients from 13 sites. A two-fold variation in the probability of PI-RADS 4 or 5 assignment across sites persisted even after adjustment for patient risk (heterogeneity p < 0.001 for both). There were significant differences in the absolute risk of GG ≥2 disease for PI-RADS 4 and 5 (heterogeneity p < 0.001 for both), varying between 23% and 68% and between 49% and 87%, respectively. The use of prostate biopsy as a reference standard has limitations but reflects typical usage of mpMRI in clinical practice.</p><p><strong>Conclusions and clinical implications: </strong>The probability of being assigned PI-RADS 4 or 5 and subsequent detection of GG ≥2 disease varies widely between institutions. This impacts counseling, risk stratification, and clinical practice, necessitating better standardization in the performance and interpretation of mpMRI.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":9.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976835","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":"Total and Regional Changes in Body Composition in Metastatic Hormone-sensitive Prostate Cancer Patients Randomized to Receive Androgen Deprivation + Enzalutamide ± Zoledronic Acid. The BONENZA Study","authors":"Martina Buffoni ,&nbsp;Alberto Dalla Volta ,&nbsp;Francesca Valcamonico ,&nbsp;Marco Bergamini ,&nbsp;Irene Caramella ,&nbsp;Donatella D’Apollo ,&nbsp;Andrea Zivi ,&nbsp;Giuseppe Procopio ,&nbsp;Piera Sepe ,&nbsp;Gianluca Del Conte ,&nbsp;Nunzia Di Meo ,&nbsp;Silvia Foti ,&nbsp;Stefania Zamboni ,&nbsp;Caterina Messina ,&nbsp;Eleonora Lucchini ,&nbsp;Roberto Maroldi ,&nbsp;Marta Laganà ,&nbsp;Marco Ravanelli ,&nbsp;Manuel Zamparini ,&nbsp;Francesca Zacchi ,&nbsp;Alfredo Berruti","doi":"10.1016/j.euo.2025.02.006","DOIUrl":"10.1016/j.euo.2025.02.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>The reduction of lean body mass (LBM) and the increase of fat body mass (FBM) caused by androgen deprivation therapy (ADT) administered to prostate cancer patients are well known to lead to an increased risk of sarcopenia. The effects of the addition of androgen receptor pathway inhibitors (ARPIs) to ADT on body composition have not been studied thoroughly.</div></div><div><h3>Methods</h3><div>BONENZA (NCT03336983) is a prospective phase 2 trial in which metastatic hormone-sensitive prostate cancer patients were randomized to receive ADT plus enzalutamide with (EZ arm) or without (E arm) the addition of zoledronic acid. Total and regional body composition parameters were evaluated by dual-energy x-ray absorptiometry (DXA) scans at baseline and after 18 mo of therapy.</div></div><div><h3>Key findings and limitations</h3><div>Eighty-nine patients (46 from the EZ arm and 43 from the E arm) had paired DXA evaluation at both time points. After 18 mo of therapy, FBM increased by +22.8% (<em>p</em> &lt; 0.001), LBM reduced by –6.7% (<em>p</em> &lt; 0.001), and appendicular lean mass index (ALMI) decreased by –9.2% (<em>p</em> &lt; 0.001). The increase in FBM varied considerably according to body districts: from +36.1% in the right arms (<em>p</em> &lt; 0.001) to +3.7% in the head (<em>p</em> &lt; 0.01). Similarly, the decrease in LBM ranged from –9.4% (<em>p</em> &lt; 0.001) in the right arm to –6.4% (<em>p</em> &lt; 0.001) in the trunk. None of the patients met the criteria for sarcopenic obesity; however, after 18 mo of treatment, 11.76% of patients had FBM &gt;40.8%, 3.5% of patients had an ALMI of &lt;5.5, and the ALMI/FBM ratio decreased by –23.9% (<em>p</em> &lt; 0.001). Age and baseline LBM influenced these body composition changes significantly, with younger patients (&lt;70 yr) and those with higher baseline LBM experiencing more marked changes.</div></div><div><h3>Conclusions and clinical implications</h3><div>Body composition undergoes a significant change with the addition of ARPIs to ADT, with an increase in FBM and a reduction in LBM, which are twice as high as those expected with ADT alone. DXA has been proved to be a reliable tool for monitoring body composition, and an assessment of district variations can aid in implementing individual-supervised physical exercise to prevent the risk of sarcopenic obesity.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 3","pages":"Pages 782-791"},"PeriodicalIF":8.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975714","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":"Novel Molecular Biomarkers to Guide Treatment Decision-making in Metastatic Urothelial Cancer-A Patient Cohort Analysis.","authors":"Debbie G J Robbrecht, Youssra Salhi, John W M Martens, Maureen J B Aarts, Paul Hamberg, Michiel S van der Heijden, Jens Voortman, Niven Mehra, Hans M Westgeest, Ronald de Wit, Reno Debets, Joost L Boormans, J Alberto Nakauma-González","doi":"10.1016/j.euo.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.euo.2025.04.007","url":null,"abstract":"<p><p>The current options and recent developments in the field of systemic therapy for advanced urothelial cancer (UC) patients urge the need for selection criteria to identify the most optimal therapeutic option for individual patients. The molecular makeup of tumors, including molecular subtype, tumor microenvironment composition, and gene mutations, fusions, and amplifications, has previously been correlated with a response to immune checkpoint inhibitors, erdafitinib, or enfortumab vedotin (EV) monotherapy, and may withhold potential candidate biomarkers. In this study, we aimed to stratify metastatic UC (mUC) patients based on molecular biomarkers that might be associated with a response to EV, a fibroblast growth factor receptor inhibitor, or anti-PD-(L)1, by using whole-genome DNA-sequencing and paired RNA-sequencing data of fresh-frozen metastatic tumor biopsies of 155 mUC patients. We observed that NECTIN4 amplification, FGFR2/3 mutations, and the RNA expression-based T-cell-to-stroma enrichment (TSE) score were mutually exclusive, and may therefore reflect biologically distinct tumors and sensitivity to treatments. This finding was validated in two independent bladder cohorts: the IMvigor210 study and The Cancer Genome Atlas. Stratification of patients into subgroups based on these molecular features is possible. Our data challenge the concept of a one-treatment-fits-all paradigm and support the rationale for prospective clinical trials with biomarker-guided treatment selection of mUC patients.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960572","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 Outcomes in Patients with Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography-detected Oligometastatic Prostate Cancer Treated with Metastasis-directed Radiotherapy as the Single Treatment Modality.","authors":"Katelijne C C de Bie, Lotte G Zuur, Dennie Meijer, Philip Meijnen, Karel A Hinnen, Daniela E Oprea-Lager, Pim J van Leeuwen, Andre N Vis","doi":"10.1016/j.euo.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.euo.2025.04.002","url":null,"abstract":"<p><strong>Background and objective: </strong>In patients with biochemical recurrence (BCR), prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) can detect oligometastatic prostate cancer (PCa). However, the optimal treatment approach for oligometastatic disease remains unclear. This study aims to assess the oncological outcomes of metachronous oligometastatic PCa patients treated with metastasis-directed radiotherapy (MDRT).</p><p><strong>Methods: </strong>We retrospectively evaluated patients with hormone-sensitive, metachronous oligometastatic PCa who underwent MDRT for BCR (from July 2012 to September 2022). Patients had one to four lymph nodes and/or bone metastases on PSMA PET/CT and were irradiated with 5 × 7 or 3 × 10 Gy. The biochemical response to MDRT was assessed as undetectable prostate-specific antigen (PSA) at follow-up, PSA response (PSA ≤ pretreatment level), or biochemical progression (PSA > pretreatment level). Biochemical progression-free survival (bPFS) and local remission of disease (absence of disease at the MDRT site on follow-up PSMA PET/CT or undetectable PSA) were evaluated.</p><p><strong>Key findings and limitations: </strong>Eighty patients underwent MDRT for 105 PSMA PET/CT-confirmed lesions. The median time from curative treatment to MDRT was 55 mo (interquartile range [IQR] 31-103). At a median follow-up of 32 mo after MDRT (IQR 21-64), 10% of the patients were PSA free, 10% had a PSA response, and 80% experienced biochemical progression. The bPFS rates at 1 and 2 yr were 54% and 38%, respectively. A total of 87% of patients had local control of disease after MDRT, whereas 72% had new metastatic lesions on repeated PSMA PET/CT. Limitations include the retrospective design and a small cohort.</p><p><strong>Conclusions and clinical implications: </strong>MDRT for oligometastatic disease shows high local efficacy. However, disease progression is observed in a substantial proportion of patients.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062584","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":"Presence of an Artificial Intelligence-powered Predictive Biomarker Is Associated with a Poor Response to Intravesical Bacillus Calmette-Guerin but Not to Intravesical Sequential Gemcitabine/Docetaxel in Patients with High-grade Non-muscle-invasive Bladder Cancer.","authors":"Vignesh T Packiam, Ian M McElree, Saum Ghodoussipour, Vivek Nimgaonkar, Viswesh Krishna, Joon Kyung Kim, Derek B Allison, Jordan R Richards, K D Anand Rajan, Stephanie J Chen, Yair Lotan, Stephen B Williams, Haochen Zhang, Drew Watson, Damir Vrabac, Waleed M Abuzeid, Anirudh Joshi, Ashish M Kamat, Michael A O'Donnell, Patrick J Hensley","doi":"10.1016/j.euo.2025.04.006","DOIUrl":"10.1016/j.euo.2025.04.006","url":null,"abstract":"<p><p>Intravesical bacillus Calmette-Guerin (BCG) is considered first-line adjuvant therapy for high-risk or high-grade non-muscle-invasive bladder cancer (NMIBC). Recently, sequential intravesical gemcitabine and docetaxel (Gem/Doce) has emerged as a promising alternative to intravesical BCG. Biomarkers to select the optimal treatment regimen could facilitate clinical decision-making. The Computational Histologic Artificial Intelligence (CHAI) platform was previously used to develop an artificial intelligence-augmented histologic assay (CHAI biomarker) that identified patients with NMIBC at an increased risk of recurrence and progression events following BCG treatment. In this study, we assessed use of the CHAI biomarker among patients with treatment-naive high-grade NMIBC who received intravesical BCG or Gem/Doce. Among patients with the presence of the CHAI biomarker, those treated with BCG had a 24-mo high-grade recurrence-free survival (HG-RFS) rate of 56% (95% confidence interval [CI] 43-73%) and those treated with Gem/Doce had an HG-RFS rate of 90% (95% CI 79-100%; hazard ratio [HR] 5.4, 95% CI 1.6-18.3, p = 0.007). Among patients with an absence of the CHAI biomarker, those treated with BCG or Gem/Doce had no significant difference in HG-RFS (HR 1.3, 95% CI 0.6-2.6, p = 0.5). The interaction term between the CHAI biomarker and the treatment type was significant (p = 0.029), indicating an association between the biomarker and the clinical outcome that is dependent on the treatment received. This study suggests that the CHAI biomarker predicts which specific high-grade NMIBC patients are less likely to benefit from BCG and may benefit from alternative treatments including, potentially, Gem/Doce.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005098","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":"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":"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":9.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371474/pdf/","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":"OA","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 ,&nbsp;Guillaume Grisay ,&nbsp;Julien Van Damme ,&nbsp;Verane Achard ,&nbsp;Laura S. Mertens ,&nbsp;Thierry N. Boellaard ,&nbsp;David D’Haese ,&nbsp;Beatrice Fournier ,&nbsp;Anne-Sophie Govaerts ,&nbsp;Robert Huddart ,&nbsp;Francesco Soria ,&nbsp;Lars Dyrskjøt ,&nbsp;Yves Allory ,&nbsp;Martina Pecoraro ,&nbsp;Saskia Litiere ,&nbsp;Bertrand Tombal ,&nbsp;Valeria Panebianco ,&nbsp;Yohann Loriot","doi":"10.1016/j.euo.2025.03.005","DOIUrl":"10.1016/j.euo.2025.03.005","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 3","pages":"Pages 603-607"},"PeriodicalIF":8.3,"publicationDate":"2025-04-16","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}