Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Venous thromboembolism in patients with urothelial carcinoma receiving systemic therapy.","authors":"Irene Huebner-Resch, Nicolai A Huebner, Regina Girgis, Renate Pichler, Eva Zebedin-Brandl, Johanna Krauter, Manuela Schmidinger, David D'Andrea, Shahrokh F Shariat, Melanie R Hassler","doi":"10.1016/j.urolonc.2026.03.004","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.03.004","url":null,"abstract":"<p><strong>Background: </strong>Patients with urothelial carcinoma (UC) undergoing systemic therapy face an increased risk of venous thromboembolism (VTE). While the Khorana Risk Score (KRS) is widely applied in oncology to predict VTE, its performance in UC remains uncertain. This study evaluated VTE incidence and clinical predictors in a real-world UC cohort.</p><p><strong>Methods: </strong>A retrospective cohort study of 140 patients with bladder or upper-tract UC treated with systemic therapy (2008-2020) was conducted. Clinical and laboratory data, including KRS variables, treatment details, and venous catheter (VC) status, were analyzed. Logistic regression, ROC, and decision curve analyses (DCA) assessed predictive factors and model performance.</p><p><strong>Results: </strong>VTE occurred in 24 patients (17.1%) during a median follow-up of 22.4 months. Among KRS components, only erythropoietin (EPO) use showed a statistically significant association with VTE (OR 4.70; 95% CI: 0.96-22.82, p = 0.049). Independent predictors were regional lymph node (LN) metastases (OR 4.35; 95% CI: 1.63-11.94, p = 0.003) and long-term VC presence (OR 4.78; 95% CI: 1.41-22.64, p = 0.023). No other KRS components or traditional factors were significant. None of the patients on therapeutic anticoagulation developed VTE. A multivariable model including EPO, LN metastases, and VC achieved numerically higher predictive accuracy compared with KRS (AUC 0.73 vs. 0.65) and showed greater net clinical benefit on DCA at 5%-40% thresholds.</p><p><strong>Conclusions: </strong>UC patients on systemic therapy face a high VTE risk not well captured by the KRS. Incorporating EPO use, LN status, and VC presence may improve prediction and support the need for UC-specific risk models to guide thromboprophylaxis.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782344","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":"Automation of four nephrometry scores using 3D models in renal cell carcinoma.","authors":"Saar Vermijs, Joris Vangeneugden, Lara Demeyere, Marthe Termote, Pieter De Visschere, Pieter De Backer, Camille Berquin, Karel Decaestecker, Charlotte Debbaut, Charles Van Praet","doi":"10.1016/j.urolonc.2026.03.002","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.03.002","url":null,"abstract":"<p><strong>Objectives: </strong>Nephrometry scores quantify renal tumor complexity to standardize reporting, however, manual calculation is time-consuming and prone to interobserver variability. Furthermore, 2-dimensional preoperative imaging limits anatomical interpretation. Therefore, we developed a fully automated method using 3-dimensional (3D) models to calculate 4 established scoring systems: RENAL, PADUA, C-index and CSA, and benchmarked them against manual calculations for validation.</p><p><strong>Methods: </strong>Preoperative CT scans and manually segmented 3D models of 80 patients undergoing robot-assisted partial nephrectomy at Ghent University Hospital were analyzed. 3 observers (student, resident, expert) manually scored each CT.Automated 3D scores were generated using our Python-based algorithm. Discrepant resident-expert scores were re-evaluated to reach consensus for comparison with automatic scores. Interobserver variability was assessed using intraclass correlation coefficients (ICC). Scoring durations were compared using paired t-tests. Pearson correlation coefficients were calculated between automated/manual scores and surgical complexity metrics: estimated blood loss (EBL), operative time (OT), and warm ischemic time (WIT).</p><p><strong>Results: </strong>Manual interobserver agreement was moderate to good (ICC(2,1) = 0.72-0.90). Re-evaluation was needed in 67 cases (83.75%). Automated scores demonstrated moderate to good agreement with manual consensus (ICC(3,1) = 0.68-0.89) and substantially reduced scoring time (manual = 5.9 minutes vs. automated = 0.2 minutes; p < 0.001). Expert re-evaluation confirmed automated accuracy in 92.9% of reviewed cases. Correlations with EBL, OT, and WIT did not differ significantly between manual and automated methods (p > 0.1).</p><p><strong>Conclusions: </strong>Our fully automated 3D model-based calculations of RENAL, PADUA, C-index, and CSA offer improved reproducibility, accuracy and efficiency while maintaining clinical validity.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723708","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":"Novel immunotherapies for prostate cancer.","authors":"George Mo, Vivek Narayan","doi":"10.1016/j.urolonc.2026.111092","DOIUrl":"10.1016/j.urolonc.2026.111092","url":null,"abstract":"<p><p>Since the advent of the autologous dendritic cell-based vaccine, sipuleucel-T, in 2010, the clinical development of immunotherapeutic approaches in advanced prostate cancer has largely been lacking. Aside from the infrequent use of pembrolizumab immune checkpoint blockade in rare molecularly-selected patients, no further immune approaches have achieved regulatory approval. Numerous challenges exist that preclude successful clinical development, including an immunologically-excluded tumor immune microenvironment, off-target and/or inflammatory toxicities that narrow the therapeutic window, and limited durability of anti-tumor responses. Nevertheless, recent advances in drug design and cellular engineering have reinvigorated interest in novel immunotherapeutic approaches in prostate cancer. This review provides an overview of the current landscape of novel immunotherapy clinical development for prostate cancer, with a focus on chimeric antigen receptor (CAR) T cells, T cell engagers, monoclonal antibodies, and cancer vaccine approaches that have produced promising early phase clinical data.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":"111092"},"PeriodicalIF":2.3,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699443","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":"Distinct pathways of disease progression with dual checkpoint blockade versus immunotargeted therapy in metastatic renal cell carcinoma","authors":"Ilya Tsimafeyeu ,&nbsp;Fuad Guliyev ,&nbsp;Bakytzhan Ongarbayev ,&nbsp;Gunel Musaeva ,&nbsp;Ramil Abdrakhmanov ,&nbsp;Vyacheslav Chubenko ,&nbsp;Olga Baklanova ,&nbsp;Ruslan Zukov ,&nbsp;Vladislav Petkau ,&nbsp;Dilyara Kaidarova","doi":"10.1016/j.urolonc.2025.110989","DOIUrl":"10.1016/j.urolonc.2025.110989","url":null,"abstract":"<div><h3>Background</h3><div>Patterns of progression under immuno-oncology regimens in metastatic renal cell carcinoma (mRCC) remain poorly described. This study characterizes site-specific disease progression in patients receiving first-line dual immunotherapy or immunotargeted therapy.</div></div><div><h3>Methods</h3><div>This retrospective, observational cohort study included patients with clear-cell metastatic renal cell carcinoma treated between 2018 and 2024 with standard-dose regimens of nivolumab-ipilimumab (IO-IO) or pembrolizumab-axitinib and avelumab-axitinib combinations (IO-axitinib). The primary endpoint was the occurrence of new metastatic lesions at progression. Secondary endpoints included progression by &gt;20% increase in target lesion size.</div></div><div><h3>Results</h3><div>Of 334 patients identified, 233 were evaluable for analysis. Radiographic progression occurred in 86.3% of IO-IO and 60% of IO-axitinib. Development of new metastatic lesions was more frequent with Nivo-Ipi (39.3% vs. 22.2%), most commonly involving the lungs and bones. In contrast, IO-axitinib combinations showed a greater propensity for progression through enlargement of pre-existing lesions (77.8% vs. 60.7%), accompanied by the emergence of new adrenal gland metastases. Across both treatment groups, lymph nodes emerged as the most frequent new site of disease progression.</div></div><div><h3>Conclusions</h3><div>Nivo-Ipi was associated with more frequent development of new metastatic lesions, particularly in the lungs, bones, and lymph nodes, while axitinib-based combinations more often resulted in regrowth of existing disease with higher rates of adrenal involvement.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110989"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025455","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":"Molecular pathology of rare histologic variants and treatment-resistant lineages of prostate cancer","authors":"Ryuta Watanabe M.D., Ph.D. ,&nbsp;Noriyoshi Miura M.D., Ph.D. ,&nbsp;Tadahiko Kikugawa M.D., Ph.D. ,&nbsp;Takashi Saika M.D., Ph.D. ,&nbsp;Michael C. Haffner M.D., Ph.D. ,&nbsp;Peter S. Nelson M.D.","doi":"10.1016/j.urolonc.2025.110987","DOIUrl":"10.1016/j.urolonc.2025.110987","url":null,"abstract":"<div><div>Rare histological variants of prostate cancer—including ductal adenocarcinoma, intraductal carcinoma of the prostate (IDC-P), neuroendocrine carcinoma, basal cell/adenoid cystic carcinoma, squamous cell carcinoma, sarcomatoid carcinoma, and stromal tumors—exhibit highly diverse biological behaviors and distinct molecular features. Accurate pathological recognition is essential, as these entities frequently diverge from conventional acinar adenocarcinoma in morphology, genomic alterations, therapeutic responsiveness, and clinical outcomes. Intraductal carcinoma of the prostate (IDC-P) and ductal adenocarcinoma often display genomic instability and aggressive clinical behavior, including enrichment for homologous recombination repair (HRR) defects and hypoxia-related pathways. Neuroendocrine subtypes, including <em>de novo</em> and treatment-related NEPC as well as double-negative prostate cancer (DNPC), are characterized by androgen receptor (AR) independence, <em>RB1/TP53</em> loss, low prostate-specific antigen (PSA) production, and poor prognosis, reflecting lineage plasticity under therapeutic pressure. Other rare tumors—such as basal cell carcinoma/adenoid cystic carcinoma, squamous cell carcinoma, and stromal tumors (STUMP and prostatic stromal sarcoma)—demonstrate unique pathological patterns and limited responsiveness to standard systemic therapies, underscoring the importance of tailored diagnostic and management strategies. This review integrates the histopathological, molecular, and emerging spatial transcriptomic insights across this spectrum of rare and treatment-resistant prostate cancer subtypes. By highlighting shared mechanisms such as genomic instability, androgen receptor (AR) pathway bypass, and microenvironmental remodeling, we outline key diagnostic considerations and evolving therapeutic implications relevant to precision oncology.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110987"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079505","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":"Efficacy and safety of tislelizumab plus intravesical chemotherapy in recurrent high-risk non-muscle-invasive bladder cancer: A retrospective single-center real-world study","authors":"Qing Chen PhD ,&nbsp;Rongpan Wu PhD ,&nbsp;Chen Zhang PhD ,&nbsp;Jiaxin Xie PhD ,&nbsp;Yi Wang PhD ,&nbsp;Xufeng Yu PhD ,&nbsp;Wei He PhD ,&nbsp;Maoyu Wang PhD ,&nbsp;Junjie Zhao PhD ,&nbsp;Zhensheng Zhang PhD ,&nbsp;Shuxiong Zeng PhD ,&nbsp;Chuanliang Xu PhD","doi":"10.1016/j.urolonc.2025.110988","DOIUrl":"10.1016/j.urolonc.2025.110988","url":null,"abstract":"<div><h3>Background</h3><div>Recurrent high-risk non-muscle-invasive bladder cancer (HR-NMIBC) poses significant therapeutic challenges due to frequent recurrences. <em>Bacillus</em> Calmette-Guérin (BCG) therapy limitations including global shortages, resistance and adverse effect. Patients often decline cystectomy due to significant impact on quality of life and complications, underscoring the need for effective bladder-preserving strategies.</div></div><div><h3>Methods</h3><div>In a retrospective single-center analysis, 43 recurrent HR-NMIBC patients received intravenous tislelizumab every 3 weeks for up to 17 cycles alongside intravesical chemotherapy. Intravesical instillation agents included gemcitabine, epirubicin or mitomycin C administered per protocol. The primary endpoint was 3-month complete response rate, defined as absence of tumor confirmed by biopsy, cystoscopy, cytology and imaging. Secondary endpoints encompassed duration of response, survival metrics, and adverse events graded per CTCAE v5.0.</div></div><div><h3>Results</h3><div>Among 43 recurrent HR-NMIBC patients with median age 67 years, 88.4% achieved 3-month complete response. Responders maintained a 24-month sustained response rate of 71.1% during median 28.4-month follow-up. The entire cohort demonstrated 36-month progression-free survival, overall survival, and cancer-specific survival rates of 82.8%, 85.0%, and 95.0% respectively. Subgroups with variant histology, BCG-unresponsive/intolerant disease, or multiple prior recurrences showed reduced responses. Treatment-related adverse events occurred in 90.7% of patients, with urinary frequency and hematuria being most common, which might stem from intravesical chemotherapy exposure. Grade 3 events affected 18.6% of patients, while immune-related adverse events led to discontinuation in 4.7%. No grade 4 or 5 toxicities were observed.</div></div><div><h3>Conclusion</h3><div>Tislelizumab plus intravesical chemotherapy achieves high response rates and durable survival benefits with manageable toxicity in recurrent HR-NMIBC, representing a promising non-BCG-dependent bladder-preserving strategy for surgically ineligible patients.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110988"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025456","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":"LncRNA NPSR1-AS1 affects the malignant biological behavior of bladder cancer through miR-199a-3p and the clinical value of urine-derived lncRNA NPSR1-AS1","authors":"Weijing He M.D. ,&nbsp;Yong Wen M.D. ,&nbsp;Huiling Qin M.D.","doi":"10.1016/j.urolonc.2025.12.016","DOIUrl":"10.1016/j.urolonc.2025.12.016","url":null,"abstract":"<div><h3>Background</h3><div>The alteration of long noncoding RNA (lncRNA) expression is significantly associated with the occurrence and progression of various human tumors.</div></div><div><h3>Aim</h3><div>To explore the possible mechanism by which lncRNA NPSR1-AS1 affects bladder cancer, as well as its diagnostic and prognostic value.</div></div><div><h3>Material and methods</h3><div>The data related to bladder cancer were mined from the GEO database. RT-qPCR was used to determine the expression of lncRNA NPSR1-AS1 and miR-199a-3p in BCa tissues, cell lines and urine. Cell proliferation, migration and apoptosis and other cell functions were tested in UMUC3, T24 and cells. The interactions between molecules were studied using the luciferase reporter gene, RIP and Spearman correlation analysis. ROC, K-M and COX regression analyses were used to evaluate the clinical value of lncRNA NPSR1-AS1.</div></div><div><h3>Results</h3><div>The lncRNA NPSR1-AS1 was expressed at higher levels in BCa tissue cell lines and urine, while miR-199a-3p expression of was decreased. The lncRNA NPSR1-AS1 affected the malignant biological behavior of BCa by sponging miR-199a-3p. Cell function experiments demonstrated that silencing lncRNA NPSR1-AS1 could inhibit the proliferation, migration and apoptosis of UMUC3, T24 and RT4 cells, while the inhibition of miR-199a-3p reversed this effect. Clinically, lncRNA NPSR1-AS1 may serve as a diagnostic and prognostic marker for BCa.</div></div><div><h3>Conclusion</h3><div>LncRNA NPSR1-AS1 targets miR-199a-3p and affects the progression of BCa. Moreover, it can serve as a biomarker for BCa.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110980"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012401","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":"Incremental dose-response effect of age on mortality in non-seminoma testis cancer patients","authors":"Reha-Baris Incesu M.D. ,&nbsp;Mattia Luca Piccinelli M.D. ,&nbsp;Simone Morra M.D. ,&nbsp;Lukas Scheipner M.D. ,&nbsp;Stefano Tappero M.D. ,&nbsp;Francesco Barletta M.D. ,&nbsp;Cristina Cano Garcia M.D. ,&nbsp;Zhe Tian M.Sc. ,&nbsp;Fred Saad M.D. ,&nbsp;Shahrokh F. Shariat M.D. ,&nbsp;Felix K.H. Chun M.D. ,&nbsp;Alberto Briganti M.D., Ph.D. ,&nbsp;Carlo Terrone M.D. ,&nbsp;Sascha Ahyai M.D. ,&nbsp;Nicola Longo M.D. ,&nbsp;Ottavio de Cobelli M.D. ,&nbsp;Derya Tilki M.D. ,&nbsp;Markus Graefen M.D. ,&nbsp;Pierre I. Karakiewicz M.D.","doi":"10.1016/j.urolonc.2026.110991","DOIUrl":"10.1016/j.urolonc.2026.110991","url":null,"abstract":"<div><h3>Background</h3><div>Age ≥ 40 predisposes to higher testis cancer-specific mortality (CSM) in non-seminoma. However, it is unknown, whether an incremental dose-response effect applies to subgroups of testis cancer patients (tertiles aged ≥ 40). We tested this hypothesis in contemporary non-seminoma patients.</div></div><div><h3>Methods</h3><div>The Surveillance, Epidemiology, and End Results (SEER) database (2004−2018) was used. Kaplan-Meier plots and multivariable Cox regression models tested the effect of age on CSM after stratification for stage (I vs. II vs. III).</div></div><div><h3>Results</h3><div>Of 13,679 non-seminoma patients, 11,034 (81%) were aged &lt; 40 vs. 2,645 (19%) were aged ≥ 40. Of patients aged ≥ 40, 943 were aged 40 to 44 (young age tertile) vs. 855 were aged 45 to 52 (intermediate age tertile) vs. 847 were aged ≥ 53 (old age tertile). In overall multivariable analyses relative to patients aged &lt; 40, young age tertile (Hazard ratio [HR] 1.4, <em>P</em> &lt; 0.01), intermediate age tertile (HR 1.9, <em>P</em> &lt; 0.001) and old age tertile (HR 3.6, <em>P</em> &lt; 0.001) were associated with higher CSM. In stage-specific multivariable analyses relative to patients aged &lt; 40, old age tertile predicted higher CSM in stage I (HR 4.7, <em>P</em> &lt; 0.001), stage II (HR 9.9, <em>P</em> &lt; 0.001) and stage III (HR 3.0, <em>P</em> &lt; 0.001). In stage III, intermediate age tertile (HR 1.9, <em>P</em> &lt; 0.001) and young age tertile (HR 1.5, <em>P</em> = 0.007) also predicted higher CSM.</div></div><div><h3>Conclusions</h3><div>We identified a dose-response effect of increasing age in non-seminoma patients aged ≥ 40, in the overall analysis as well as in stage-specific analyses.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110991"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137854","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":"Not all PI-RADS 3 lesions are the same: Higher rate of clinically significant prostate cancer among Black men on targeted biopsy in a diverse cohort","authors":"David G Hanelin ,&nbsp;Priya Dave M.D. ,&nbsp;Andrewe Baca M.D. ,&nbsp;Morgan Joseph ,&nbsp;Rutul Patel M.D. ,&nbsp;Alexander Sankin M.D. ,&nbsp;Ahmed Aboumohamed M.D. ,&nbsp;Stephen Reese M.D. ,&nbsp;Ilir Agalliu M.D., Sc.D. ,&nbsp;Kara Watts M.D.","doi":"10.1016/j.urolonc.2026.110995","DOIUrl":"10.1016/j.urolonc.2026.110995","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Radiogenomic studies suggest phenotypic differences in prostate cancer (PCa) appearance on MRI across racial groups. Counseling for PI-RADS 3 lesions is particularly challenging due to low positive predictive value and limited multi-ethnic data. We evaluated the association between PI-RADS score and PCa detection on MRI-targeted biopsy across a diverse patient population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of patients who underwent MRI-targeted fusion biopsy for PI-RADS 3 to 5 lesions between 2016 and 2024. Demographic and pathologic data were collected. Mixed-effects logistic regression assessed associations between race and PCa and csPCa, adjusting for clinical/radiographic features, stratified by PI-RADS score.</div></div><div><h3>Results</h3><div>646 patients with 1,146 lesions were analyzed (mean age 63.2 ± 7.6). The cohort was 48.1% Non-Hispanic Black (NHB), 32.5% Hispanic, and 19.3% Non-Hispanic White (NHW). PCa detection rates were 45.0% in NHB, 36.0% in Hispanic, and 35.8% in NHW. NHB had increased odds of overall and csPCa detection compared to NHW (Odds Ratio [OR] = 2.00; 95% Confidence Interval [95% CI] 0.96–4.18; <em>P</em> = 0.06, OR = 1.78, 95% CI 0.85–3.71; <em>P</em> = 0.12). On biopsy of PI-RADS 3 lesions, NHB men demonstrated nearly fivefold higher odds of csPCa detection compared to NHW and Hispanic cohorts (OR = 4.86; 95% CI 1.26–18.77; <em>P</em> = 0.02). No significant differences were observed between Hispanic and NHW men.</div></div><div><h3>Conclusions</h3><div>NHB had significantly higher odds of csPCa detection on targeted biopsy of PI-RADS 3 lesions. These findings support emerging data that phenotypic appearance of prostate cancer on MRI differs by race and may be relevant for risk stratification and management counseling of PI-RADS 3 lesions.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110995"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158511","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":"Circulating tumor DNA in urothelial cancer as an intermediate disease state between localized and advanced stages: Moving from risk factors to micrometastatic disease in the perioperative setting","authors":"Sergio Bracarda M.D.,&nbsp;Giulia Mammone M.D.,&nbsp;Claudia Mosillo M.D.,&nbsp;Grazia Sirgiovanni M.D.,&nbsp;Annalisa Guida M.D.","doi":"10.1016/j.urolonc.2025.110986","DOIUrl":"10.1016/j.urolonc.2025.110986","url":null,"abstract":"<div><div>Urothelial carcinoma, especially muscle-invasive bladder cancer, presents a high risk of recurrence despite curative-intent surgery and perioperative therapies. A major clinical challenge remains the early identification of micrometastatic disease, undetectable with conventional imaging. Circulating tumor DNA (ctDNA), a minimally invasive biomarker, is emerging as a transformative tool for detecting minimal residual disease, allowing for earlier intervention and more tailored and efficacious treatment strategies. This review explores the evolving role of ctDNA in urothelial carcinoma, particularly in the perioperative setting. The negative adjuvant IMvigor010 trial established ctDNA as a prognostic and potentially predictive marker, demonstrating that ctDNA-positive patients postcystectomy were at higher risk of relapse but could benefit from adjuvant immunotherapy. Building on this, IMvigor011 prospectively validated a ctDNA-guided immunotherapy approach, showing that ctDNA clearance correlates with improved disease-free survival. We discuss ctDNA potential to redefine disease staging, introducing an “intermediate” category (M0, ctDNA-positive) between localized and overtly metastatic disease. ctDNA also offers value in surveillance, treatment de-escalation, and monitoring therapeutic response. Advances in tumor-informed assays have enhanced the sensitivity of ctDNA detection, though standardization and accessibility remain key challenges. In summary, ctDNA represents a paradigm shift in urothelial carcinoma management, enabling precision oncology through real-time disease monitoring and personalized treatments. Its integration into clinical practice may improve outcomes by addressing micrometastatic disease before clinical relapse or progression, transforming the way we stratify and treat patients across the urothelial carcinoma continuum.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110986"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025454","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}