Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Real-world outcomes of nadofaragene firadenovec for BCG-unresponsive non–muscle-invasive bladder cancer: A multicenter experience","authors":"Jacob A. Moyer B.S. ,&nbsp;Lanyu Mi M.S. ,&nbsp;Mimi V. Nguyen M.D. ,&nbsp;Adri M. Durant M.D. ,&nbsp;Andrew J. Zganjar M.D. ,&nbsp;Timothy D. Lyon M.D. ,&nbsp;Paras H. Shah M.D. ,&nbsp;Stephen A. Boorjian M.D. ,&nbsp;Mark D. Tyson II M.D., M.P.H.","doi":"10.1016/j.urolonc.2025.10.023","DOIUrl":"10.1016/j.urolonc.2025.10.023","url":null,"abstract":"<div><h3>Background</h3><div>Nadofaragene firadenovec-vncg received US Food and Drug Administration approval for bacille Calmette-Guérin (BCG)–unresponsive non–muscle-invasive bladder cancer (NMIBC) based on prospective efficacy and safety results. However, postmarketing data are lacking. This study evaluates outcomes in a real-world setting.</div></div><div><h3>Methods</h3><div>We analyzed data for patients treated at Mayo Clinic from November 2023 through December 2024. Outcomes included complete response (CR) rate, duration of response, adverse events, and high-grade recurrence-free (HGRFS), cystectomy-free, and overall survival.</div></div><div><h3>Results</h3><div>Forty-six patients were treated with nadofaragene firadenovec; 3 with pending posttreatment cystoscopy were excluded. Of 24 evaluable patients with carcinoma in situ with/without papillary disease, 79% had a CR at 3 months. The median response duration was not reached; 68% (13/19) of responders still had CRs with median follow-up of 9.3 months. Of 19 patients with papillary-only disease (median follow-up of 7.6 months), HGRFS at 3, 6, and 12 months was 68%, 53%, and 26%, respectively. With median follow-up of 13.9 months, cystectomy-free and overall survival were 93% and 95%, respectively. Progression occurred in 5 patients. The most common adverse events were grade 1-2 bladder spasms (61%) and failure to fully retain the instillation (33%). Four patients had grade 3 events; there were no grade 4 or 5 events. Limitations include the small sample size and limited follow-up.</div></div><div><h3>Conclusions</h3><div>Real-world data confirm the efficacy and safety of nadofaragene firadenovec, clarifying its role in the management of BCG-unresponsive NMIBC.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 118.e15-118.e21"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145550999","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":"Outcomes of enfortumab vedotin plus pembrolizumab in patients with advanced urothelial cancer and severe renal dysfunction","authors":"Henry K. Litt M.D.,&nbsp;Ronac Mamtani M.D., M.S.C.E.,&nbsp;Ryan D. Chow M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.10.016","DOIUrl":"10.1016/j.urolonc.2025.10.016","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Enfortumab vedotin plus pembrolizumab (EV+P) is now the standard first-line (1L) therapy for advanced urothelial cancer (aUC), based on improved survival in the EV-302 trial. However, the trial excluded patients with creatinine clearance (CrCl) &lt;30 ml/min, leaving an evidence gap for patients with severely impaired renal function. To address this, we evaluated outcomes of EV+P in patients with aUC and CrCl &lt;30 ml/min using real-world data.</div></div><div><h3>Methods</h3><div>We conducted a real-world retrospective cohort study using a database derived from electronic health records from approximately 280 U.S. oncology practices. Adults with aUC initiating 1L EV+P between April 2023 and December 2024 were included. Outcomes included overall survival (OS), progression-free survival (PFS), and EV interruption-free survival (IFS), stratified by baseline CrCl (≥30 vs. &lt;30 ml/min). We constructed multivariable Cox models adjusted for demographics, clinical factors, and potential confounders.</div></div><div><h3>Results</h3><div>Among 462 eligible patients who initiated 1L EV+P between April 2023 and December 2024, 65 (14.1%) had CrCl &lt;30 ml/min. In multivariable Cox models, severely impaired renal function was not associated with worse overall survival (OS) (adjusted HR [aHR] = 0.95, 95% CI [0.61–1.49]; <em>P</em> = 0.84), progression-free survival (PFS) (aHR = 0.70 [0.47–1.06]; <em>P</em> = 0.092), or EV interruption-free survival (IFS) (aHR = 0.82 [0.48–1.38]; <em>P</em> = 0.45).</div></div><div><h3>Conclusions</h3><div>These real-world findings indicate that patients with CrCl &lt;30 ml/min experienced outcomes comparable to those with higher renal function, providing important evidence in a population that is often excluded from clinical trials.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 118.e1-118.e5"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524387","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 and oncological outcomes of incomplete thermal ablations with or without immediate retreatment for patients with small renal masses","authors":"Letizia Maria Ippolita Jannello M.D. ,&nbsp;Stefano Luzzago M.D. ,&nbsp;Mattia Luca Piccinelli M.D. ,&nbsp;Francesco A. Mistretta M.D. ,&nbsp;Chiara Vaccaro M.D. ,&nbsp;Marco Tozzi M.D. ,&nbsp;Elena Lievore M.D. ,&nbsp;Daniele Maiettini M.D. ,&nbsp;Giovanni Cordima M.D. ,&nbsp;Maria Giovanna Pitoni M.D. ,&nbsp;Giulia Corrao M.D. ,&nbsp;Paolo Della Vigna M.D. ,&nbsp;Giulia Marvaso M.D. ,&nbsp;Guido Bonomo M.D. ,&nbsp;Barbara Alicja Jereczek-Fossa M.D., Ph.D. ,&nbsp;Gennaro Musi M.D. ,&nbsp;Franco Orsi M.D.","doi":"10.1016/j.urolonc.2025.11.002","DOIUrl":"10.1016/j.urolonc.2025.11.002","url":null,"abstract":"<div><h3>Objective</h3><div>Thermal ablation (TA) offers an alternative to partial nephrectomy in treating small renal masses (SRMs). However, little is known about the perioperative outcomes of incomplete TA or the effects of re-ablation for residual masses.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively analyzed 551 SRMs (cT1a-b) treated with TA at a single center (2008–2022). Apparent incomplete ablation was defined as contrast enhancement on a 24-hour computed tomography, while true incomplete ablation was confirmed by persistent enhancement at a 6-week follow-up. Multivariable logistic regression models assessed predictors of apparent incomplete ablation. Kaplan–Meier (KM) plots evaluated local recurrence rates (LRR), systemic recurrence (SR), cancer-specific survival (CSS), and overall survival (OS) in patients with complete vs. true incomplete ablation. Scatter plots analyzed renal function in single or multiple TA sessions. Finally, a sensitivity analysis was conducted for biopsy-proven renal cell carcinoma.</div></div><div><h3>Results</h3><div>Of 551 patients, 49 (8.9%) and 29 (5.2%) experienced apparent and true incomplete ablation, respectively. Predictors of apparent incomplete ablation included higher RENAL complexity (moderate odds ratio [OR]: 3.96, <em>P</em> &lt; 0.001; high OR: 3.47, <em>P</em> = 0.026), larger tumors (OR: 1.69, <em>P</em> &lt; 0.001), and greater comorbidity burden (age-adjusted Charlson Comorbidity Index OR: 1.27, <em>P</em> = 0.004). KM plots showed no differences in LRR (<em>P</em> = 0.79), SR (<em>P</em> = 0.19), CSS (<em>P</em> = 0.56), or OS (<em>P</em> = 0.14) between complete and true incomplete ablation groups. Of 29 patients with true incomplete ablation, 27 underwent re-ablation, with scatter plots showing no adverse effects of multiple TAs on kidney function. The sensitivity analysis restricted to biopsy-proven RCC (<em>n</em> = 438) confirmed the robustness of our findings.</div></div><div><h3>Conclusion</h3><div>Apparent incomplete ablation occurred in 8.9% of cases, but only 5.2% had true incomplete ablation requiring re-ablation. Multiple TA sessions were effective, renal function was preserved, and tumor-related outcomes were unaffected.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 124.e1-124.e8"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597673","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":"Oncological outcomes of deferred systemic therapy for patients with metastatic renal cell carcinoma: A systematic review and quantitative analysis","authors":"Ichiro Tsuboi M.D. ,&nbsp;Pawel Rajwa M.D. ,&nbsp;Marcin Miszczyk M.D. ,&nbsp;Tamás Fazekas M.D. ,&nbsp;Akihiro Matsukawa M.D. ,&nbsp;Mehdi Kardoust Parizi M.D. ,&nbsp;Robert Schulz M.D. ,&nbsp;Stefano Mancon M.D. ,&nbsp;Ekaterina Laukhtina M.D. ,&nbsp;Tatsushi Kawada M.D., Ph.D. ,&nbsp;Satoshi Katayama M.D., Ph.D. ,&nbsp;Takehiro Iwata M.D., Ph.D. ,&nbsp;Kensuke Bekku M.D., Ph.D. ,&nbsp;Koichiro Wada M.D., Ph.D. ,&nbsp;Pierre I. Karakiewicz M.D., Ph.D. ,&nbsp;Piotr Chlosta M.D., Ph.D. ,&nbsp;Motoo Araki M.D., Ph.D. ,&nbsp;Shahrokh F. Shariat M.D., Ph.D. ,&nbsp;Riccardo Campi","doi":"10.1016/j.urolonc.2025.11.008","DOIUrl":"10.1016/j.urolonc.2025.11.008","url":null,"abstract":"<div><h3>Background and Objective</h3><div>While some patients with metastatic renal cell carcinoma (mRCC) may experience an indolent disease progression and could benefit from deferred systemic therapy (ST), including active surveillance (AS) or metastasis-directed therapy (MDT), the evidence on its oncological efficacy and safety are still not well-established. We aimed to provide an overview of the available evidence on oncological outcomes of patients with mRCC undergoing deferred ST.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was conducted in August 2024 using the PubMed, Scopus, and Embase databases to identify prospective and retrospective studies evaluating AS or deferred ST for patients with mRCC (PROSPERO ID: CRD42024579021). The co-primary outcomes were ST-free survival (ST-FS) and overall survival (OS). A random-effects model was used for quantitative analysis.</div></div><div><h3>Key Findings and Limitations</h3><div>We identified 15 eligible studies including 2,912 patients. Of these, 4 were prospective (<em>n</em> = 589 patients) and 11 were retrospective (<em>n</em> = 2,323 patients). The estimated 1-, 2-, 3-, 4-, and 5-year ST-FS rates (<em>n</em> = 1,070) were 74%, 54%, 49%, 43%, and 37%, respectively. The estimated 1-, 2-, 3-, 4-, and 5-year OS rates (<em>n</em> = 2,872) were 96%, 89%, 80%, 71%, and 69%, respectively. Key limitations at a study-level included selection bias, unmeasured confounding, and variability across deferred ST/AS protocols, including the indications for metastasis-directed therapy. Moreover, most studies used tyrosine kinase inhibitors as ST. The proportion of patients receiving MDT, including metastasectomy or stereotactic body radiation therapy, ranged from 14 to 100%.</div></div><div><h3>Conclusions and Clinical Implications</h3><div>Deferring ST by AS or MDT was associated with favorable oncological outcomes in carefully-selected patients with mRCC, highlighting the potential value of this approach in the contemporary multidisciplinary management of mRCC. Considering the limitations of available evidence and the lack of data on the oncological efficacy and safety of deferred ST for mRCC in the immune-oncology era, our review calls for further research in this field.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 92-101"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752364","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":"Re-examining the predictive value of preoperative IL-6 in urothelial carcinoma: A constructive appraisal","authors":"Parth Aphale Ph.D.,&nbsp;Himanshu Shekhar B.H.M.S.,&nbsp;Shashank Dokania B.H.M.S.","doi":"10.1016/j.urolonc.2025.11.014","DOIUrl":"10.1016/j.urolonc.2025.11.014","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 116-117"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757889","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":"Evaluation of kynurenine and tryptophan metabolism in bladder cancer: Diagnostic and prognostic implications of IDO1 polymorphism","authors":"Kemal Kayar M.D., FEBU ,&nbsp;Rıdvan Kayar M.D., FEBU ,&nbsp;Dilara Sönmez ,&nbsp;Mehmet Tolgahan Hakan Ph.D. ,&nbsp;Cem Horozoğlu Ph.D. ,&nbsp;Ömer Ergin Yücebaş M.D. ,&nbsp;İlhan Yaylım ,&nbsp;Levent Verim","doi":"10.1016/j.urolonc.2025.11.011","DOIUrl":"10.1016/j.urolonc.2025.11.011","url":null,"abstract":"<div><h3>Objective</h3><div>The tryptophan–kynurenine (TRP–KYN) pathway, regulated by indoleamine 2,3-dioxygenase 1 (IDO1), plays a pivotal role in tumor immune escape. Altered TRP catabolism and IDO1 gene polymorphisms may influence bladder cancer (BC) behavior through immune metabolic mechanisms. To evaluate the diagnostic and prognostic value of plasma and urinary KYN/TRP ratios and the IDO1 rs10089084 (<em>G</em> &gt; <em>C</em>) polymorphism in patients with BC.</div></div><div><h3>Methods</h3><div>In this case-control study, plasma and urine samples were obtained from 58 patients with BC and 70 healthy controls before diagnostic cystoscopy. TRP and KYN levels were quantified by high-performance liquid chromatography. IDO1 rs10089084 genotypes were determined via PCR-RFLP. Diagnostic accuracy was assessed by ROC analysis, and recurrence risk was analyzed using Cox regression.</div></div><div><h3>Results</h3><div>Plasma KYN/TRP ratios were significantly higher in BC patients than in controls (<em>P</em> = 0.011; AUC = 0.617). Among BC cases, the urinary KYN/TRP ratio discriminated patients with a visible bladder mass (AUC = 0.879; 95% CI 0.774–0.984; cut-off = 0.0895; sensitivity = 100%; specificity = 70.8%). In recurrence analysis, the IDO1 rs10089084 C allele independently predicted recurrence risk (HR = 7.51; 95% CI 1.70–33.10; <em>P</em> = 0.008). No association was found with progression.</div></div><div><h3>Conclusions</h3><div>Combined metabolic and genetic profiling implicates the IDO1-TRP-KYN axis in BC pathophysiology. Urinary KYN/TRP ratio offers a noninvasive, biologically grounded marker for intravesical tumor activity, while the IDO1 rs10089084 variant provides complementary prognostic information. These findings support the integration of immunometabolic biomarkers into risk-adapted surveillance strategies.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 119.e17-119.e25"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716000","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":"Comparative prognostic performance of KEYNOTE-564 and AUA risk stratification in nonmetastatic clear cell renal cell carcinoma","authors":"Giuseppe Garofano ,&nbsp;Cesare Saitta ,&nbsp;Giacomo Musso ,&nbsp;Margaret F. Meagher ,&nbsp;Alberto Saita ,&nbsp;Massimo Lazzeri ,&nbsp;Umberto Capitanio ,&nbsp;Mai Dabbas ,&nbsp;Alessandro Larcher ,&nbsp;Riccardo Autorino ,&nbsp;Savio D. Pandolfo ,&nbsp;Dattatraya Patil ,&nbsp;Kazutaka Saito ,&nbsp;Yosuke Yasuda ,&nbsp;Hajime Tanaka ,&nbsp;Giovanni Fontana ,&nbsp;Francesco Montorsi ,&nbsp;Giovanni Lughezzani ,&nbsp;Paolo Casale ,&nbsp;Yasuhisa Fujii ,&nbsp;Ithaar H. Derweesh","doi":"10.1016/j.urolonc.2025.10.014","DOIUrl":"10.1016/j.urolonc.2025.10.014","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare KEYNOTE-564 and American Urological Association (AUA) risk classifications in clear cell renal cell carcinoma (ccRCC), as recurrence after treatment for localized RCC remains a significant clinical challenge, and no consensus exists on how to define high-risk disease.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective multicenter study of surgically treated patients with nonmetastatic ccRCC. Patients were stratified by AUA and KEYNOTE-564 criteria, and overall survival (OS), cancer specific survival (CSS) and recurrence free survival (RFS) were assessed using Kaplan-Meier and Cox regression analyses. Concordance index (C-index) was used to assess discrimination, and Net Reclassification Improvement (NRI) to evaluate reclassification; both were estimated with 1,000 bootstrap replications.</div></div><div><h3>Results</h3><div>Among 5,711 patients included, the AUA model showed superior discrimination for RFS compared to KEYNOTE-564 (C-index 0.71 vs. 0.68; <em>P</em> = 0.03), with higher recurrence risk in intermediate- (HR 2.38), high- (HR 2.92), and very high-risk groups (HR 3.68) vs. low-risk (all <em>P</em> &lt; 0.001). For OS, both models showed identical discrimination (C-index 0.73; <em>P</em> = 0.67). For CSS, discrimination was similar (AUA 0.79 vs. KEYNOTE-564 0.78; <em>P</em> = 0.65). NRI analysis showed that the KEYNOTE model was disadvantaged for RFS (–1.71%; <em>P</em> = 0.04), while differences in OS (–0.68%; <em>P</em> = 0.19) and CSS (–1.20%; <em>P</em> = 0.19) were not statistically significant.</div></div><div><h3>Conclusions</h3><div>The AUA classification showed better discrimination for RFS, and improved reclassification compared to KEYNOTE-564, likely due to inclusion of adverse features such as sarcomatoid/rhabdoid differentiation and positive surgical margins. These findings suggest that broader inclusion criteria may improve risk stratification and should be prospectively validated in future adjuvant trials.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 121.e15-121.e23"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565598","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":"Understanding the role of statin use on advanced prostate cancer outcomes: Does the statin type, cumulative dose, or duration impact survival?","authors":"Alexa Rose León B.S. ,&nbsp;Michael Risk M.D., Ph.D. ,&nbsp;William A. Ricke Ph.D. ,&nbsp;Jinn-ing Liou M.S. ,&nbsp;David F. Jarrard M.D. ,&nbsp;Kyle A. Richards M.D.","doi":"10.1016/j.urolonc.2025.11.004","DOIUrl":"10.1016/j.urolonc.2025.11.004","url":null,"abstract":"<div><h3>Objective</h3><div>To further investigate the association of improved survival in men with prostate cancer (PCa) on androgen deprivation therapy (ADT), we hypothesized that increased duration and dose of statin in men with PCa on ADT would show a greater effect.</div></div><div><h3>Methods</h3><div>Using Veterans Affairs databases, we identified all men diagnosed with PCa between 2000 and 2008 that were treated with ADT with follow-up through May 2016. Exclusions included treatment with ADT or statins for ≤6 months or ADT receipt concurrently with localized radiation. Patients were stratified by cumulative duration of statin use &lt;36 or ≥36 months, and we adjusted for cumulative dose and statin type. Cox proportional hazards ratios were calculated for overall survival (OS) and cancer-specific survival (CSS) after propensity score adjustment.</div></div><div><h3>Results</h3><div>The cohort after exclusions consisted of 52,763 patients: 32% had a cumulative duration use of statins &lt;36 months. Our analysis for OS showed improved survival in the ≥36 months group (HR 0.60, 95% CI 0.57–0.63), the highest cumulative dose group (HR 0.90, 95% CI 0.82–0.99), and hydrophilic group (HR 0.58, 95% CI 0.54–0.62). In our competing risks analysis for CSS, we noted improved survival in the ≥36 months group (HR 0.83, 95% CI 0.73–0.95) and the highest cumulative dose group (HR 0.74, 95% CI 0.59–0.93), but statin type was not associated with improved survival (HR 0.82, 95% CI 0.66–1.01).</div></div><div><h3>Conclusions</h3><div>We show a strong minimum effective dose/duration type relationship with statin use in Veterans with PCa receiving ADT.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 125.e23-125.e31"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574705","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":"PSA response to predict progression in metastatic hormone-sensitive prostate cancer (mHSPC) patients. When is the optimal time point?","authors":"Rocío Martínez-Corral ,&nbsp;Daniel Pérez-Fentes ,&nbsp;Celia Bardella-Altarriba ,&nbsp;Francisco Javier Vera-Ballesteros ,&nbsp;Arnau Abella-Serra ,&nbsp;Sergio Antón Fuente ,&nbsp;María Elena Martínez-Corral ,&nbsp;Natalia Picola-Brau ,&nbsp;Alicia López-Abad ,&nbsp;Álvaro Gómez-Ferrer ,&nbsp;Manuel Beamud-Cortés ,&nbsp;Jose Francisco Suárez-Novo ,&nbsp;Pedro Angel López-González ,&nbsp;Mireia García-Puche ,&nbsp;Ana María Álvarez-Gracia ,&nbsp;Pedro De Pablos-Rodríguez","doi":"10.1016/j.urolonc.2025.10.012","DOIUrl":"10.1016/j.urolonc.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>The combination of androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) has transformed the treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC), becoming one of the most widely used standard treatment options. The depth of PSA declines following initiation of ADT plus ARPI—typically defined as a PSA ≤0.2 ng/ml—has shown promise as a reliable prognostic marker for risk stratification in mHSPC patients. This study aimed to identify the most informative time point for PSA response to predict disease progression.</div></div><div><h3>Methods</h3><div>Retrospective multicenter study of mHSPC patients treated with ADT+ARPI between June 2017 and October 2024, registered in a real-world clinical database. Patients receiving ADT monotherapy, triplet therapy or initiating ARPI more than 6 months after starting ADT were excluded. The primary objective was to assess the predictive value of PSA response at 3, 6, and 9 months for disease progression within 18 months of treatment initiation. Predictive performance was evaluated using discriminant analysis. Groups were defined based on time cut-offs. Patients were classified as biochemical complete response (BCR, PSA ≤0.2 ng/ml) or nonresponse (PSA &gt;0.2 ng/ml) at each time point. Secondary objectives included comparing progression-free survival (PFS) between BCR and NR groups at 6 and 9 months and identifying clinical predictors of progression.</div></div><div><h3>Results</h3><div>A total of 599 mHSPC patients were included, with a median follow-up of 24 months. Median age at diagnosis was 72 years, and median baseline PSA was 20 ng/ml. BCR rates at 3, 6, and 9 months were 48%, 60%, and 53%, respectively. PSA response demonstrated strong predictive accuracy for progression at 18 months, with the 9-month cutoff showing the highest discriminative ability (AUC = 0.87). The negative predictive value (NPV) was high across all time points (0.92, 0.95, and 0.97), while the positive predictive value (PPV) remained limited (0.44, 0.38, and 0.38). Kaplan–Meier analysis showed significantly longer PFS in BCR versus NR groups at both 6 and 9 months (<em>p</em> &lt; 0.0001). Multivariable analysis identified NR status and high-volume disease as independent predictors of progression.</div></div><div><h3>Conclusion</h3><div>PSA response at 9 months was the most accurate time point for identifying patients unlikely to experience progression at 18 months. Its high negative predictive value (NPV) supports its potential role in risk stratification, while the limited positive predictive value highlights the need for additional markers to better guide treatment decisions</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 124.e9-124.e15"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477023","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":"Disparities and temporal trends in referral for bladder cancer diagnosis: A worsening epidemic","authors":"Amanda A. Myers M.D. ,&nbsp;Zhigang Duan M.S. ,&nbsp;Daniel A. Igel M.D. ,&nbsp;Alexis R. Steinmetz M.D. ,&nbsp;Valentina Grajales M.D. ,&nbsp;Kelly K. Bree M.D. ,&nbsp;Hui Zhao Ph.D. ,&nbsp;Sharon H. Giordano M.D. ,&nbsp;Ashish M. Kamat M.D.","doi":"10.1016/j.urolonc.2025.11.012","DOIUrl":"10.1016/j.urolonc.2025.11.012","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze temporal trends in time intervals from hematuria diagnosis to urology evaluation and cystoscopy in patients with bladder cancer and identify opportunities for improved interventions.</div></div><div><h3>Materials and Methods</h3><div>We identified 84,515 Medicare beneficiaries in the SEER-Medicare database diagnosed with bladder cancer between 2005 and 2019, with hematuria claims within 12 months prior to diagnosis and urology visits thereafter. The co-primary outcome was delay (&gt;30 days) and severe delay (&gt;60 days) from hematuria claim to urology visit. The secondary outcome was delay (&gt;14 days) and severe delay (&gt;30 days) from urology visit to cystoscopy. We used joinpoint regression and logistic regression analyses.</div></div><div><h3>Results</h3><div>Delays from hematuria claim to urology visit increased over time; the proportion of patients experiencing a delay of over 30 days rose from 30.8% in 2005 to 35.1% in 2016, (Annual Percent Change (APC) 0.89%, <em>P</em> = NS).This trend accelerated significantly after 2016, reaching 39.2% in 2019 (APC 3.68%, <em>P</em> &lt; 0.001). Females faced higher rates of delays throughout the study period. Females were 1.40 times more likely to experience a delay in their urology visit than males (aOR 1.40, 95% CI 1.34–1.46). Other variables associated with delay included Black and Hispanic race/ethnicity, not married, higher Charlson score, and residence. A preexisting relationship with a urologist reduced the delay likelihood (aOR 0.83, 95% CI 0.79–0.87).</div></div><div><h3>Conclusions</h3><div>Female patients continue to experience a disproportionately delayed urologic referral which has, unfortunately. worsened over time. To ensure equitable and timely diagnosis of bladder cancer, future interventions must focus on streamlining the initial referral process.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 120.e1-120.e11"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744615","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}