Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Is ipsilateral systematic biopsy combined with targeted biopsy the optimal substitute for bilateral systematic biopsy combined with targeted biopsy: A systematic review and meta-analysis.","authors":"Qiyou Wu, Xiang Tu, Jinjiang Jiang, Jianjun Ye, Tianhai Lin, Zhenhua Liu, Lu Yang, Shi Qiu, Bo Tang, Yige Bao, Qiang Wei","doi":"10.1016/j.urolonc.2024.11.023","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.11.023","url":null,"abstract":"<p><strong>Background: </strong>The current standard prostate biopsy method, which combine systematic biopsy (SB) with targeted biopsy (TB), has shortcomings such as overdiagnosis and overtreatment. To evaluate the effectiveness of ipsilateral systematic biopsy (ips-SB) combined with targeted biopsy (ips-SB+TB) and contralateral SB (con-SB) combined with TB (con-SB+TB) as potential alternatives to SB+TB.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in Cochrane, Embase, Ovid, and PubMed databases until September 2024. 2,732 references were identified, and 11 records were included.</p><p><strong>Main findings: </strong>The study included a total of 5,249 patients and revealed that ips-SB+TB detected slightly less PCa than SB+TB with a relative risk (RR) of 0.95 (95% CI 0.91, 1.00), P = 0.05. In terms of csPCa detection, ips-SB+TB showed a comparable detection rate with SB+TB (RR 0.98 [95% CI 0.94, 1.01], P = 0.60). There was a statistically significant difference in csPCa detection between con-SB+TB and SB+TB (RR 0.92 [95% CI 0.86, 0.99], P = 0.02). The detection rates of clinically insignificant PCa (ciPCa) were comparable between con-SB+TB vs. SB+TB (con-SB+TB vs. SB+TB: RR 0.90 [95% CI 0.79, 1.04], P = 0.15). However, fewer ciPCa cases were detected in ips-SB+TB compared to SB+TB (RR 0.86 [95% CI 0.75, 0.99], P = 0.04).</p><p><strong>Conclusions: </strong>In this review, our analysis highlights ips-SB+TB has the comparable detection efficiency of PCa and csPCa compared to SB+TB, and its potential to be the substitute of the SB+TB with less cores and less detection of ciPCa.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risks of grade reclassification among patients with Gleason grade group 1 prostate cancer and PI-RADS 5 findings on prostate MRI.","authors":"Vinaik Mootha Sundaresan, Lindsey Webb, Maximilian Rabil, Aleksandra Golos, Ryan Sutherland, Jonell Bailey, Pawel Rajwa, Tyler M Seibert, Stacy Loeb, Matthew R Cooperberg, William J Catalona, Preston C Sprenkle, Isaac Y Kim, Michael S Leapman","doi":"10.1016/j.urolonc.2024.11.007","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.11.007","url":null,"abstract":"<p><strong>Background and objective: </strong>As most Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions on MRI harbor Gleason grade (GG) group ≥2 disease on biopsy, optimal management of patients with imaging-biopsy discordance remains unclear. To estimate grade misclassification, we evaluated the incidence of Gleason upgrading among patients with GG1 disease in the setting of a PI-RADS 5 lesion.</p><p><strong>Methods: </strong>We conducted a single-institution retrospective analysis to identify patients with GG1 prostate cancer on fusion biopsy with MRI demonstrating ≥1 PI-RADS 5 lesion. Primary study outcome was identification of ≥GG2 disease on subsequent active surveillance (AS) biopsy or radical prostatectomy (RP). We used multivariable models to examine factors associated with reclassification.</p><p><strong>Results: </strong>We identified 110 patients with GG1 disease on initial biopsy and ≥1 PI-RADS 5 lesion. There were 104 patients (94.6%) initially managed with AS and 6 (5.5%) received treatment. Sixty-one patients (58.7%) on AS underwent additional biopsies. Of these, 43 (70.5%) patients had tumor upgrading, with 32 (74.4%) upgraded on first surveillance biopsy. Forty-four (40%) patients ultimately received treatment, including prostatectomy in 15 (13.6%) and radiation in 25 (22.7%). Two patients (1.8%) developed metastases. In multivariable models, genomic classifier score was associated with upgrading. Limitations include a lack of multi-institutional data and long-term outcomes data.</p><p><strong>Conclusions: </strong>Most patients diagnosed with GG1 prostate cancer on MRI-Ultrasound fusion biopsy in the setting of a PI-RADS 5 lesion were found to have ≥GG2 disease on subsequent tissue sampling, suggesting substantial initial misclassification and reinforcing the need for confirmatory testing.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of race and payor status on patterns of utilization of partial and radical nephrectomy in patients with renal cell carcinoma in California.","authors":"Regina Barragan-Carrillo, Nicholas Salgia, Karyn S Eilber, Sumanta K Pal, Kai Dallas, Maria T Bourlon","doi":"10.1016/j.urolonc.2024.11.026","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.11.026","url":null,"abstract":"<p><strong>Background: </strong>Prospective trials have shown similar outcomes with partial nephrectomy (PN) in patients with localized renal cell carcinoma (RCC), and multiple studies suggest increasing the use of the technique. We hypothesize that patients who stem from minority groups, as well as Medicare and Medical, have less access to this specialized procedure and, therefore, have a higher rate of radical nephrectomy (RN).</p><p><strong>Methods: </strong>We interrogated the California Office of Statewide Health Planning and Development (OSHPD) database, which collects information from all inpatient admissions, emergency room visits and inpatient/outpatient procedures in the state. All patients undergoing nephrectomy for RCC were identified from 2012 to 2018 using CPT and ICD-9/10 codes to identify patients with RCC undergoing RN and PN. Variables of interest included patient demographics, comorbidities, payor status and type of institution where the surgery was performed. We performed univariate and multivariable analysis to explore associations between patient factors and type of nephrectomy performed.</p><p><strong>Results: </strong>In total, 31,093 patients who had undergone a nephrectomy in the study period were identified. Overall, most were 57% male, with a mean age of 58 years. PN and RN were performed in 15,840 (50.9%) and 15,253 (49.1%) patients, respectively. PN rates differed according to race/ ethnicity, as it was performed in 8576 (53.1%) White, 1124 (55.3%) Black, 1286 (46.0%) Asian, 4107 (47.5%) Hispanic and 747 (50.5%) other race patients (P < 0.001). Use of PN also differed among patients based on payor status, with 6800 (56.4%) private, 5,036 (43.9%) Medicare, 1,817 (38.3%) Medical, and 2,187 (77.7%) other insurance patients (P < 0.001). On multivariate analysis controlling for age, gender, comorbidities, and frailty, race was independently associated with the type of nephrectomy, but payor was not.</p><p><strong>Conclusions: </strong>Our study confirms that race and payor status may have an influence on the utilization of partial versus status radical nephrectomy, with the highest rate of partial nephrectomies among Black patients and those with private insurance. Although there are multiple potential confounders (e.g., latency of diagnosis and resulting tumor size/complexity), it is possible access to care is a driver of this phenomenon.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative outcomes, environmental impact and economic implications of pelvic drain discontinuation in prostate cancer patients undergoing robot-assisted radical prostatectomy.","authors":"Simone Scuderi, Pietro Scilipoti, Luigi Nocera, Mattia Longoni, Leonardo Quarta, Paolo Zaurito, Francesco Barletta, Francesco Pellegrino, Mario de Angelis, Daniele Robesti, Antony Pellegrino, Armando Stabile, Alessandro Larcher, Francesco Montorsi, Alberto Briganti, Giorgio Gandaglia","doi":"10.1016/j.urolonc.2024.11.022","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.11.022","url":null,"abstract":"<p><strong>Purpose: </strong>The utility of a pelvic drain (PD) after robot-assisted radical prostatectomy (RARP) has been recently questioned. We investigated the impact of discontinuing PD placement after RARP on complications, pain, environmental benefits, and cost savings.</p><p><strong>Methods: </strong>We identified 1,199 patients who underwent RARP with or without extended pelvic lymph node dissection from 2016 to 2023 at a referral center. Starting in 2018, PD placement was discontinued in uncomplicated RARPs. Complications were collected following the European Association of Urology (EAU) recommendations on reporting and grading. Multivariable logistic regression models (MLR) evaluated the impact of PD use on perioperative outcomes and opioid usage. The PD life cycle-associated Carbon Dioxide Equivalent Emissions (CO2e) and its economic impact were estimated.</p><p><strong>Results: </strong>A PD was placed in a total of 555 (46%) patients, with a decreasing rate from 94% to 18% between 2016 and 2023. The rates of any and high-grade (HG) complications were similar between patients with and without PD (29 vs. 28% and 5% vs. 6%, respectively; all P ≥ 0.2). At MLR, the PD placement was not associated with the risk of any (OR:1.09, 95%CI:0.79-1.5) or HG complications (OR 1.45, 95%CI 0.80-2.63). PD placement was associated with greater postoperative opioid usage (OR:1.58, 95%CI:1.01-2.51, P = 0.045). The CO2e spared rose from 220 in 2016 to 2,180 in 2022 and cost savings per year increased from 1,855€ in 2016 to 18,506€ in 2022.</p><p><strong>Conclusion: </strong>Unnecessary PD placement should be avoided in uncomplicated RARPs to obtain environmental benefits, reduce health-related costs, and improve patients' outcomes.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported functional outcomes and treatment-related regret in Hispanic and Spanish-speaking men following prostate cancer treatment.","authors":"Andrea A Lopez, Bashir Al Hussein Al Awamlh, Li-Ching Huang, Zhiguo Zhao, Tatsuki Koyama, Karen E Hoffman, Christopher J D Wallis, Kerri Cavanaugh, Ruchika Talwar, Alicia K Morgans, Michael Goodman, Ann S Hamilton, Xiao-Cheng Wu, Jie Li, Brock B O'Neil, David F Penson, Daniel A Barocas","doi":"10.1016/j.urolonc.2024.11.024","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.11.024","url":null,"abstract":"<p><strong>Objectives: </strong>Compare functional outcomes and treatment-related regret over 10 years in Spanish- and English-speaking Hispanic men compared to non-Hispanic men following treatment of localized prostate cancer.</p><p><strong>Methods and materials: </strong>Data from a prospective cohort study of men with localized prostate cancer treated with active surveillance, radical prostatectomy or radiotherapy were used to examine the effect of survey language (Spanish speaking vs. English speaking) and ethnicity (Hispanic vs. non-Hispanic) on functional outcomes and treatment-related regret over 10 years. Outcomes were measured using validated questionaries adjusting for baseline patient and disease characteristics.</p><p><strong>Results: </strong>A total of 770 men were included, 12% were Spanish-speaking and 12% were English-speaking Hispanic men. Compared to non-Hispanic men, Spanish-speaking Hispanic men had clinically meaningfully better urinary incontinence scores at years 3, 5 and 10 (adjusted mean difference [aMD], 12.4, 95% CI, 4.8 to 20.0; at year 10), as well as better bowel function scores at 10 years (aMD, 5.1, 95% CI 2.3 to 8.0). English-speaking Hispanic men had clinically worse urinary incontinence at 3 and 5 years (aMD, -10.7 [95% CI, -17.6 to -3.9]; at year 5) and bowel function at 10 years (aMD, -4.3 [95% CI, -8.2 to -0.4]) compared to Spanish-speaking Hispanic men. English-speaking Hispanic men were more likely to report regret than Spanish-speaking Hispanic men at 10 years (adjusted odds ratio, 7.9, 95% CI, 1.3-46.2).</p><p><strong>Conclusions: </strong>These findings underscore the importance of considering language and ethnicity when providing counseling and support for prostate cancer survivors, emphasizing the need for personalized patient-centered care.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the genetic profile of prostate cancer.","authors":"Ayodeji Folorunsho Ajayi, Moses Agbomhere Hamed, Moyinoluwa Comfort Onaolapo, Ogundipe Helen Fiyinfoluwa, Oluwatosin Imoleayo Oyeniran, David Tolulope Oluwole","doi":"10.1016/j.urolonc.2024.11.018","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.11.018","url":null,"abstract":"<p><p>Several studies indicated that prostate cancer has a hereditary component. In particular, a significant risk of prostate cancer has been linked to a tight familial lineage. However, to provide insight into how prostate cancer is inherited, characterising its genetic profile is essential. The current body of research on the analysis of genetic mutations in prostate cancer was reviewed to achieve this. This paper reports on the effects and underlying processes of prostate cancer that have been linked to decreased male fertility. Many research approaches used have resulted in the discovery of unique inheritance patterns and manifest traits, the onset and spread of prostate cancer have also been linked to many genes. Studies have specifically examined Androgen Receptor gene variants about prostate cancer risk and disease progression. Research has shown that genetic and environmental variables are important contributors to prostate cancer, even if the true origins of the disease are not fully recognised or established. Researchers studying the genetics of prostate cancer are using genome-wide association studies more and more because of their outstanding effectiveness in revealing susceptibility loci for prostate cancer. Genome-Wide Association Studies provides a detailed method for identifying the distinct sequence of a gene that is associated with cancer risk. Surgical procedures and radiation treatments are 2 of the treatment options for prostate cancer. Notwithstanding the compelling evidence shown in this work, suggests that more research must be done to detect the gene alterations and the use of genetic variants in the treatment of prostate cancer.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective analysis of partial cystectomy in patients with muscle-invasive urothelial carcinoma: A German single-center experience.","authors":"Jacob Schmidt, Kira Furlano, Patricia Kellmer, Hans Krause, Tobias Klatte, Kurt Miller, Thorsten Schlomm, Sebastian L Hofbauer","doi":"10.1016/j.urolonc.2024.11.021","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.11.021","url":null,"abstract":"<p><strong>Objectives: </strong>Partial cystectomy (PC) has been proposed as a less invasive alternative to radical cystectomy (RC) for the treatment of localized muscle-invasive bladder cancer (MIBC). The aim of this study was to evaluate the outcome of PC in a contemporary patient cohort to identify potential risk factors for this procedure.</p><p><strong>Methods: </strong>Data from 58 MIBC patients who underwent PC were retrospectively analyzed. Demographics, tumor characteristics, clinical outcomes, and pathology results were collected. Statistical analysis was performed using Cox regression and Kaplan-Meier method to determine survival rates and risk factors.</p><p><strong>Results: </strong>The cohort consisted of 58 patients with MIBC with a median age of 71 years. The 5-year overall survival (OS), cancer specific survival (CSS) and recurrence-free survival (RFS) rates were 55%, 67% and 51%, respectively. Clinical suspicion for lymph node metastases (HR 3.82, CI 1.09-13.39, P = 0.036), advanced T-stages (HR 3.80, CI 1.38-10.49, P = 0.010), a higher grading (HR 6.57, CI 0.76-49.19, P = 0.010), positive resection margins (HR 1.81, CI 1.10-2.96, P = 0.012), lymphovascular invasion (HR 5.14, CI 1.77-14.88, P = 0.003), vascular invasion (HR 6.62, CI 2.16-20.27, P = 0. 001), and longer time from initial diagnosis to surgery (HR 1.003, CI 1.001-1.01, days, P = 0.010) were associated with decreased OS. Complications within the first 30 and 90 postoperative days were observed in 31% and 36% of patients, respectively. 4% experienced a Clavien-Dino grade III/IV complication. One patient developed acute respiratory distress syndrome and died 46 days after surgery.</p><p><strong>Conclusion: </strong>Partial cystectomy appears to be a safe bladder-sparing approach for highly selected MIBC patients with favorable oncologic outcomes and acceptable complication rates. Patient selection and assessment of tumor characteristics are essential for successful outcomes. Prospective randomized controlled trials are needed.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world survival and economic burden among patients with locally advanced or metastatic urothelial carcinoma in the United States.","authors":"Ronald C Chen, Rupali Fuldeore, Alexandra Greatsinger, Zsolt Hepp, Qing Liu, Phoebe Wright, Bin Xie, Hongbo Yang, Christopher Young, Adina Zhang, Lisa Mucha","doi":"10.1016/j.urolonc.2024.11.010","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.11.010","url":null,"abstract":"<p><strong>Background: </strong>Given the changing treatment landscape for locally advanced or metastatic urothelial carcinoma (la/mUC), this study aimed to describe real-world treatments, overall survival (OS), health care resource utilization (HCRU), and costs among US patients with la/mUC receiving first-line therapy.</p><p><strong>Methods: </strong>This retrospective study was conducted using 100% Medicare claims data (2015-2020). Patients with la/mUC were selected; initiation of first-line therapy was the index date. Treatments and OS were assessed during follow-up (index date to the earliest of end of data availability, health plan coverage, or death). All-cause HCRU and costs (2021 USD) were assessed during the first-line treatment period (index date to the earliest of first-line discontinuation, switch to second-line therapy, end of follow-up, or death). Outpatient pharmacy costs were not included. All-cause OS from start of first-line therapy was estimated using the Kaplan-Meier approach. The HCRU, cost, and OS analyses were stratified by 3 index treatment groups-platinum-based chemotherapy, non-platinum-based chemotherapy, and programmed cell death protein 1/ligand 1 (PD-1/L1) inhibitor monotherapy-and adjusted for baseline characteristics.</p><p><strong>Results: </strong>Of 9,939 patients included, 77.1% were men and mean age was 76 years. In total, 5,050 (50.8%) received platinum-based chemotherapy, 1,361 (13.7%) received non-platinum-based chemotherapy, and 3,242 (32.6%) received PD-1/L1 inhibitor monotherapy for first-line la/mUC. Median OS was 12.9, 12.9 (P = 0.960), and 9.0 months (P < 0.001) with platinum-based chemotherapy (reference), non-platinum-based chemotherapy, and PD-1/L1 inhibitor monotherapy, respectively. Most (> 99%) patients had ≥ 1 outpatient visit during the treatment period; mean number of visits per patient was 13.1 with platinum-based chemotherapy, 10.5 with non-platinum-based chemotherapy, and 18.3 with PD-1/L1 inhibitor monotherapy. In general, HCRU was significantly lower for patients receiving PD-1/L1 inhibitor monotherapy versus platinum-based chemotherapy. However, costs were significantly higher with PD-1/L1 inhibitor monotherapy versus platinum-based chemotherapy. Mean total monthly cost per patient was $10,285 for platinum-based chemotherapy, $8,982 for non-platinum-based chemotherapy, and $18,147 for PD-1/L1 inhibitor monotherapy.</p><p><strong>Conclusions: </strong>From 2015 to 2020, patients with la/mUC had substantial HCRU and costs and short survival, regardless of first-line treatment. More effective therapies were needed to prolong survival and reduce the economic burden of la/mUC.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient preferences for life expectancy cutoffs for aggressive treatment in clinically localized prostate cancer.","authors":"John R Heard, John M Masterson, Michael Luu, Rebecca Gale, Brennan Spiegel, Stephen J Freedland, Timothy J Daskivich","doi":"10.1016/j.urolonc.2024.11.020","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.11.020","url":null,"abstract":"<p><strong>Background: </strong>Guidelines for prostate cancer treatment in men with limited life expectancy are based on expert opinion. Patient preferences for when to defer treatment based on longevity are unknown. We sought to define life expectancy thresholds at which men are more likely to choose conservative management in the context of varying risks of cancer death and treatment-related side effects.</p><p><strong>Materials and methods: </strong>We crowdsourced a conjoint analysis exercise to 2,046 men sociodemographically matched to a US prostate cancer population. Subjects were given a longevity estimate based on their age and comorbidity. They then chose between treatment and conservative management across scenarios with varying risks of cancer death at 5, 10, and 15 years, erectile dysfunction, urinary incontinence, and irritative urinary symptoms. Multivariable multinomial logistic regression identified the life expectancy threshold when men were more likely to choose conservative management over treatment.</p><p><strong>Results: </strong>Across all men, there was a significant interaction between longevity and treatment choice (P < 0.001), with probability of treatment decreasing 15% for every 5-year decrease in life expectancy (OR0.85, 95% CI0.82-0.89). Across all tumor risk subtypes, men were significantly more likely to choose conservative management at life expectancy<10 years(OR<1, P < 0.05). For low-, favorable-intermediate-, unfavorable-intermediate-, and high-risk cancers, men were more likely to choose conservative management at life expectancy thresholds of ≤15, ≤10, ≤9, and ≤7 years, respectively (P < 0.05).</p><p><strong>Conclusions: </strong>Preferences for when to consider conservative management of prostate cancer based on longevity align with current guidelines recommendations, except for low-risk disease, for which men are likely to consider conservative management at even higher life expectancy thresholds.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective validation of clino-radio-pathological risk scoring system (CRiSS) for prediction of inguinal lymph-nodes metastasis in squamous cell carcinoma of penis.","authors":"Keval N Patel, Nikunj Patel, Poojitha Yalla, Abhijeet Salunke, Mohit Sharma, Ketul Puj, Vikas Warikoo, Priti Trivedi, Shashank J Pandya","doi":"10.1016/j.urolonc.2024.11.014","DOIUrl":"https://doi.org/10.1016/j.urolonc.2024.11.014","url":null,"abstract":"<p><strong>Objective: </strong>To prospectively validate the diagnostic performance of Clino-radio-pathological Risk Scoring System (CRiSS) for prediction of inguinal lymph-node metastasis (ILNM) in squamous cell carcinoma of penis.</p><p><strong>Materials and methods: </strong>A prospective observational study of all patients with SCC penis was conducted between January 1, 2021, and December 31, 2023, at our institute. Data regarding all CRiSS parameters and MRI features of >8mm size and presence of necrosis or irregular outline were recorded, and patients were assigned CRiSS scores and groups. All included patients were subjected to primary surgery (partial/total penectomy) along with bilateral radical inguinal lymph-node dissection. Multivariate logistic regression analysis was performed with both USG and MRI. Sensitivity and specificity were calculated for CRiSS scores and groups.</p><p><strong>Results: </strong>A total of 86 patients were enrolled during the study period. Size of lymph-node greater than 8mm (HR: 4.502) and irregular outline or presence of necrosis (HR: 4.002) in MRI were significantly associated with ILNM along with all other CRiSS variables in multivariate analysis. CRiSS groups had a sensitivity of 100% and a specificity of 85.71%. CRiSS could diagnose ILNM with a sensitivity of 100% in both palpable and non-palpable groins.</p><p><strong>Conclusions: </strong>CRiSS can identify patients in whom ILND can be avoided with a zero false negative rate, irrespective of clinical lymph-node status. CRiSS can identify the patients who are candidates for ILND even after a negative FNAC and biopsy of palpable lymph-nodes. It can identify patients for concomitant penectomy and ILND. MRI is a suitable replacement for ultrasonography if not standard of care (CRiSS-M).</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}