Urologic Oncology-seminars and Original Investigations最新文献

{"title":"The comeback of orchiectomy in advanced prostate cancer- is that feasible?","authors":"Alon Lazarovich, Walter M Stadler, Scott Eggener, Samuel Tremblay, Ashley Page, Hilda Diaz, Brian Heiss, Daniel M Geynisman, Natalie Reizine","doi":"10.1016/j.urolonc.2025.08.025","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.025","url":null,"abstract":"<p><strong>Background & objectives: </strong>Lifelong androgen deprivation therapy (ADT) is necessary for men with advanced prostate cancer (PCa). ADT via medical castration carries with it financial and physical toxicity. This feasibility trial evaluates the acceptance rate of surgical orchiectomy among men with metastatic PCa, assessing its viability as an alternative to ongoing medical castration.</p><p><strong>Methods: </strong>We conducted a prospective trial of PCa patients from 3 academic medical centers, who had been on ADT for at least 1 year. The primary endpoint was the proportion of patients opting for surgical orchiectomy following an educational session regarding the procedure. Secondary endpoints included participation rates in the educational session, the correlation of orchiectomy acceptance with demographic factors, the impact on quality of life metrics (sexual satisfaction, body image perception) and decision regret scale.</p><p><strong>Results: </strong>Of the 130 men approached, 101 (78%) consented to the educational session, and 58/101 (57%) consented for quality of life assessments. 27/101 (27%) consulted with a urologist about orchiectomy, and 14/101 (14%) ultimately underwent the procedure. Quality of life outcomes showed no difference between those who underwent orchiectomy and those who did not. Decision regret among orchiectomy patients was low with 93% indicating that orchiectomy was the right decision. Testicular atrophy was observed on pathology in 13 patients who underwent orchiectomy.</p><p><strong>Conclusion: </strong>We found a limited acceptance rate of 14% for surgical orchiectomy among men with PCa on ADT for at least 1 year, who were educated on the procedure.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179181","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":"Deciphering the role of zingiber officinale phytochemicals for the treatment of prostate cancer: Interactions of phytochemicals with androgen receptor prostate cancer mutant H874Y ligand binding domain.","authors":"Guanghui Lei, Shuai Yan, Xu Gao, Sireen Abdul Rahim Shilbayeh, Saeed Vohra, Shahzad Rasheed, Salah-Ud-Din Khan, Shahanavaj Khan","doi":"10.1016/j.urolonc.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The mutations in the Androgen Receptor (AR) known as H874Y in prostate cancer greatly influence cellular signaling and execute the cell proliferation. Phytochemicals of ginger (Zingiber officinale) extracted from methanol extract were investigated through multiple servers to identify the ADMET properties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our key considerations were on Gingerol and Gingerenone and their bindings with AR Prostate Cancer Mutant H874Y. Moreover, the molecular docking simulations, molecular dynamics, and simulations were executed to determine the key insight into the binding affinity, stability, and motions of the Prostate Cancer Mutant H874Y Ligand Binding Domain. In-vitro study was performed to evaluate the cytotoxicity of Zingiber officinale against 3 cell lines A549, MCF-7, and PC-3. Furthermore, cell nuclear morphology was analyzed using DAPI staining.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The ADMET investigations revealed positive results concerning absorption, distribution, metabolism, and excretion with no signs of toxicity commenced and better binding affinity for Gingerol and Gingerenone-A. The molecular dynamics simulations were employed for the Prostate Cancer Mutant H874Y Ligand Binding Domain complexed Gingernone-A and Gingerol over 100 ns to identify the atomistic motions and stability of the desired ligands. The MD Simulations revealed that Gingernone-A was found stable, suggesting more consistent bindings and stability with higher hydrogen bond contacts during simulations. Moreover, the Gingerol was found equally stable to Gingernone-A confirmed by root mean square deviations (RMSD) which reflects the dynamic nature of the Gingerol. Furthermore, other parameters such as RMSF, and compactness were found within permissible limits. To validate the molecular docking simulations as well as molecular dynamics simulations the free energy was calculated from the whole trajectory obtained from the MD Simulations using the MM-PBSA method. Both Gingerol and Gingernone-A were found to be better modulators of the H874Y mutated ligand-binding domain with free binding energy for Gingerol -189.351 ± 1.272kJ/mol and Gingernone-A -322.881 ± 1.665 kJ/mol. Such negative binding energies provide an understanding of the binding nature of ligands with the template target. Moreover, the Gingerol with AR Prostate Cancer Ligand Binding Domain binding showed free binding energy -292.984 ± 2.673 kJ/mol. These negative binding energies illustrate the ligands' binding strengths. The results of in-vitro study showed good anticancer potential in methanol extract of Zingiber officinale against A549, MCF-7, and PC-3 cell lines with IC&lt;sub&gt;50&lt;/sub&gt; values of 464, 542, and 604 μg/mL respectively. The results of DAPI staining were showed remarkable changes in cell nuclear morphology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The results of current in-siico and in-vitro studies are important for gaining an understanding of the mechanism","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138733","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":"Immunotherapy-based treatment in renal collecting duct carcinoma: A retrospective case series analysis.","authors":"Xiaowei Zeng, Zhenjie Zhu, Yedie He, Jinchao Chen","doi":"10.1016/j.urolonc.2025.08.021","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.021","url":null,"abstract":"<p><strong>Objective: </strong>Collecting duct carcinoma (CDC), a rare and aggressive renal cell carcinoma (RCC) subtype, lacks effective standard therapies for advanced stages. While immune checkpoint inhibitors (ICIs) are standard in clear cell RCC (ccRCC), their role in CDC is poorly defined, supported mainly by case reports. This study evaluated the efficacy and safety of ICI-based therapy in CDC patients.</p><p><strong>Materials and methods: </strong>This single-center retrospective case series included 11 pathologically confirmed CDC patients treated with ICI-based regimens between January 2015 and December 2024. Primary outcome was objective response rate (ORR; RECIST v1.1). Secondary outcomes included progression-free survival (PFS), overall survival (OS), and grade ≥3 treatment-related adverse events (TRAEs; CTCAE v5.0).</p><p><strong>Results: </strong>Median age was 59 years; 81.8% were male. Ten patients with metastatic disease and received immunotherapy as systemic treatment, while one received it as adjuvant therapy. Lines of immunotherapy-based treatment included: first-line (9 instances), second-line (4 instances), and third-line or beyond (2 instances). Regimens included: ICI monotherapy (n = 4 instances), ICI + chemotherapy (n = 4), ICI + targeted therapy (n = 8), and ICI + anti-HER2 ADC (RC48) (n = 1). With a median follow-up of 29 months, median OS was 42 months. Systemic ICI therapy yielded an ORR of 43.8% and disease control rate (DCR) of 81.3%. Notably, targeted-immunotherapy combinations demonstrated an ORR of 50%. One patient achieved partial response (PR) with third-line ICI + RC48 (PFS 8 months). Two exceptional cases achieved sustained complete responses (CR) exceeding 56 and 64 months, respectively. Grade ≥3 TRAEs occurred in 36.4% of patients, managed without treatment-related deaths.</p><p><strong>Conclusion: </strong>This retrospective analysis provides preliminary evidence that ICI-based therapy, particularly targeted-immunotherapy combinations, exhibits promising antitumor activity and manageable safety in CDC patients, with some achieving deep and durable responses. The observed efficacy of targeted-immunotherapy (ORR 50%) and the potential signal with anti-HER2 ADC warrant further investigation.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138731","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":"Microultrasound-targeted biopsies in patients with suspected prostate cancer: Diagnostic accuracy and clinical utility.","authors":"Isabel Sanz Gómez, Diego Fernando Carvajal, Camila Vega, Francesco Pellegrinelli, Jhonatan Alfonso Esper, Sara Anacleto, Antoni Sànchez-Puy, Sandra Tarragón, Jose Antonio Bellido, Luis Miguel Marco, Maida Bada, Laia Sabiote, Laura Gallardo, William Andrés Barragán, Anna Palazzetti, Nelly Janneth Rodríguez, Ivana Valverde, Alessio Zordani, Jose Manuel Ulloa, Begoña Juaneda, Raul Martos, David Salinas, Juan Antonio Peña","doi":"10.1016/j.urolonc.2025.08.018","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.018","url":null,"abstract":"<p><strong>Background: </strong>Microultrasound (microUS) is an emerging imaging modality that enables real-time, high-resolution prostate cancer detection.</p><p><strong>Objectives: </strong>To evaluate the diagnostic accuracy and clinical utility of microUS-targeted biopsies for the detection of clinically significant prostate cancer (csPCa) in a real-world cohort of patients with suspected disease.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 200 patients who underwent transperineal microUS-guided prostate biopsy between January 2022 and December 2024. All procedures were performed using the 29 MHz ExactVu system, applying the PRI-MUS scoring system for lesion characterization. Targeted biopsies were followed by 12-core systematic sampling. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Multivariate logistic regression was conducted to identify predictors of csPCa.</p><p><strong>Results: </strong>Prostate cancer was detected in 124 patients (62.1%), with csPCa confirmed in 84 cases (42%). Lesions with PRI-MUS ≥4 were significantly associated with csPCa (P = 0.018), yielding a sensitivity of 93% and NPV of 83%. Among patients with negative or absent multiparametric magnetic resonance imaging (mpMRI) (n = 30), microUS identified csPCa in 16.7%. ISUP grade concordance between targeted biopsies and final prostatectomy specimens was 84.8%. PRI-MUS score emerged as the strongest independent predictor of csPCa (OR: 2.96; P = 0.001). The overall complication rate was 4%, exclusively minor events.</p><p><strong>Conclusions: </strong>MicroUS-targeted biopsies demonstrate robust diagnostic performance in identifying csPCa, particularly with PRI-MUS scores ≥4. Its real-time imaging capabilities, broad accessibility, and short learning curve suggest that microUS may serve as a reliable alternative or adjunct to mpMRI in contemporary prostate cancer diagnostic pathways.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114145","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":"Transperineal 3T MRI-guided and transrectal MRI-ultrasound fusion prostate biopsies: Do lesion location and size impact diagnostic yield?","authors":"Quinn Rainer, Kemal Tuncali, Alexander Cole, Quoc-Dien Trinh, Kristine S Burk, Mark Vangel, Pedro Moreira, Nobuhiko Hata, Clare Tempany","doi":"10.1016/j.urolonc.2025.08.024","DOIUrl":"10.1016/j.urolonc.2025.08.024","url":null,"abstract":"<p><strong>Background and objective: </strong>Magnetic resonance imaging (MRI)-targeted biopsies for prostate cancer diagnosis can be performed as a transperineal biopsy (TP-Bx), yet its comparative performance with transrectal biopsy (TR-Bx) remains uncertain. We evaluated the detection of clinically significant prostate cancer (csPCa) by TP-Bx and TR-Bx according to lesion size and location using Prostate Imaging Reporting & Data System (PI-RADS) criteria.</p><p><strong>Methods: </strong>We retrospectively reviewed biopsy-naïve patients who underwent MRI-guided prostate biopsies at our institution. TR-Bx was performed using MRI-ultrasound fusion in the urology clinic, while TP-Bx utilized an MRI in-bore technique in the radiology department. Lesions were stratified by PI-RADS-defined score, location, and size.</p><p><strong>Results: </strong>Among 200 patients (100 TP-Bx, 100 TR-Bx), 276 PI-RADS score 3 to 5 lesions were biopsied (141 TP-Bx, 135 TR-Bx). Overall csPCa detection did not differ significantly between TP-Bx and TR-Bx (28% vs. 38%; OR = 1.5, CI = 0.9-2.6, P = 0.12). However, TR-Bx detected significantly more csPCa in non-apical peripheral zone (PZ) lesions compared to TP-Bx [45% (36/80) vs. 29% (21/73), adjusted OR = 4.6, 95% CI = 1.29-16.4, P = 0.019], particularly for small (diameter ≤1 cm) lesions (35% [16/46] vs. 12% [5/42], adjusted OR = 8.06, 95% CI = 1.45-44.7, P = 0.017). No significant difference was observed for larger lesions (diameter >1 cm).</p><p><strong>Conclusions: </strong>Overall csPCa detection rates were comparable between TP-Bx and TR-Bx, with no statistically significant difference. However, TR-Bx demonstrated superior detection in small non-apical PZ lesions, suggesting an anatomic and size-dependent advantage. These exploratory findings support further prospective studies to refine MRI-targeted biopsy protocols using PI-RADS-defined lesion characteristics to inform personalized biopsy strategies.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114140","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":"The influence of immunocompromised status on recurrence and progression free survival among nonmuscle invasive bladder cancers (NMIBCs) undergoing transurethral resection of bladder tumor (TURBT) and adjuvant intravesical bacillus Calmette Guerin (BCG): Analysis of USA insurance claim data.","authors":"Francesco Del Giudice, Valerio Santarelli, Jan Łaszkiewicz, Shufeng Li, Wojciech Krajewski, Łukasz Nowak, Tomasz Szydełko, Matteo Ferro, Bernardo Rocco, Felice Crocetto, Biagio Barone, Carlo Buonerba, Roberto Contieri, Renate Pichler, José Daniel Subiela, Benjamin Pradere, Marco Moschini, Andrea Mari, Keiichiro Mori, Francesco Soria, Roman Mayr, Jung Ki Jo, Mohamed Gad, Ben Challacombe, Yasmin Abu-Ghanem, Elsie Mensah, Rajesh Nair, Ramesh Thurairaja, Muhammad Shamim Khan, Benjamin I Chung","doi":"10.1016/j.urolonc.2025.07.005","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.005","url":null,"abstract":"<p><strong>Introduction: </strong>Transurethral resection of the bladder tumor (TURBT) followed by intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is a standard treatment for high-risk non muscle-invasive bladder cancer (NMIBC). However, due to potential risk of dissemination, current guidelines recommend caution when proposing BCG treatment in immunocompromised patients. Our aim was to assess the efficacy and safety of BCG treatment in immunocompromised patients.</p><p><strong>Materials and methods: </strong>Patients aged ≥18 with a diagnosis of bladder cancer (BC) who underwent BCG therapy in 2007-2021, were identified in the Merative^TM Marketscan® Research Commercial and Medicare databases. Multivariable Cox proportion hazard regressions adjusted by relevant confounders were performed to investigate the influence of immunosuppression on the events associated with progression and recurrence of BC, both in the unmatched cohort and after 1:2 propensity score matching (PSM). Also, subgroup analysis on progression in patients without cancer other than BC was conducted.</p><p><strong>Results: </strong>Immunocompromised and immunocompetent patients had similar rates of disseminated BCG infection after intravesical immunotherapy. However, immunocompromised patients had shorter progression-free survival and higher probability of progression (aHR: 1.23, 95% CI: 1.11-1.38), as well as shorter recurrence-free survival and a higher probability of recurrence (aHR: 1.13, 95% CI: 1.05-1.20). Similar significant associations were observed in the PSM cohort. A subgroup analysis of patients without any additional oncological diagnoses beyond BC confirmed a higher likelihood of progression in the immunocompromised group (aHR: 1.34, 95% CI: 1.15-1.56).</p><p><strong>Conclusions: </strong>BCG immunotherapy is safe in immunocompromised patients. Nevertheless, the efficacy of intravesical BCG in these patients might be suboptimal thus advocating the need for appropriate counselling and a possible lower threshold to consider radical treatment.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102676","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":"Senescence-associated miRNAs predict survival and modulate the tumor immune microenvironment via SPOCK1 targeting in clear cell renal cell carcinoma.","authors":"Zheng Song, Lei Zhang, Xiyue Song, Wei Luo","doi":"10.1016/j.urolonc.2025.08.020","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.020","url":null,"abstract":"<p><strong>Background: </strong>Clear cell renal cell carcinoma(ccRCC) is a highly aggressive urological malignancy originating from proximal tubular epithelial cells. Celluar senescence plays a pivotal role in tumorigenesis and shaping the immune landscape. MicroRNAs (miRNAs) are essential regulators of tumor metabolism and biological behavior, and identifying senescence-associated miRNA (CS-miRNA) signatures is critical for improving prognosis and guiding treatment strategies.</p><p><strong>Methods: </strong>We proformed multiomics analysis on 616 ccRCC samples from the TCGA-KIRC dataset and developed a CS-miRNA-based scoring system(CS-miRNAs-Score) using machine learning algorithms to evaluate clinical and immunological characteristics. The model was externally validated with miRNA-seq data from 21 clinical ccRCC samples. Based on CS-miRNA expression profiles, patients were stratified into two distinct clusters with significantly different clinical outcomes, mutation profiles,and biological pathways.</p><p><strong>Results: </strong>The CS-miRNAs-Score,comprising 10 prognostically relevant miRNAs, was significantly associated with overall survival, immune and stromal scores, immune checkpoint expression response to immunotherapy. In addition, we constructed a miRNA-mRNA interaction network and experimentally validated the tumor-suppressive role of hsa-miR-130a-3p in ccRCC. Functional assays, including CCK-8, Transwell migration, scratch wound healing, and dual-luciferase reporter assays, confirmed that has-miR-130a-3p directly binds to and inhibits SPOCK1, an oncogene in ccRCC.</p><p><strong>Conclusions: </strong>Our findings highlight the prognostic and therapeutic relevance of senescence-associated miRNAs in ccRCC, providing novel biomarkers and potential targets for personalized immunotherapy.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081956","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":"Long-term oncologic outcomes of metastatic clear-cell renal cell carcinoma after local therapy alone.","authors":"Daniel Barbakoff, Mark T Dawidek, Andrea Knezevic, Marc Ganz, Lina Posada, Yash Khandwala, Andrea Lopez Sanmiguel, Stephen W Reese, Arnold Oparanozie, Nicole Liso, Ritesh R Kotecha, Robert J Motzer, Ed Reznik, Jonathan Coleman, Irina Ostrovnaya, Martin H Voss, Paul Russo, A Ari Hakimi","doi":"10.1016/j.urolonc.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.004","url":null,"abstract":"<p><strong>Purpose: </strong>Oligometastatic clear-cell renal cell carcinoma (ccRCC) represents a heterogeneous entity that can, in select cases, be managed with primary tumor resection and complete local treatment at all metastatic sites, rendering a patient metastatic with no evidence of disease (M1 NED). M1 NED patients have improved overall survival, although previous cohorts are relatively small and heterogeneous. We sought to identify the natural history of M1 NED ccRCC to clinical trial findings and to optimize management strategies.</p><p><strong>Materials and methods: </strong>Patients with synchronous metastatic ccRCC treated with local therapy alone and considered radiographically M1 NED at our institution between 1989 and 2023 were retrospectively evaluated. Survival probabilities used a combination of Kaplan-Meier estimator, log-rank test, and multivariable Cox proportional hazards regression. When available, limited genomic data obtained using the MSK-IMPACT targeted panel was correlated with outcomes.</p><p><strong>Results: </strong>85 patients met inclusion criteria. One-year disease free survival (DFS) was 53% (95% CI: 42 to 63%). Sarcomatoid features predicted shorter DFS (HR 2.62, CI: 1.08, 6.34, P = 0.03). Time from first disease recurrence to second recurrence was longer among patients with initial DFS ≥2 years (median 42 vs. 15 months, log-rank P = 0.005). A total of 18 patients (21%) underwent targeted genomic sequencing; higher fraction of genome altered and CDKN2A copy number loss were associated with shorter DFS. Findings were limited by cohort size.</p><p><strong>Conclusions: </strong>Most M1 NED ccRCC patients will experience disease recurrence, although certain baseline risk factors appear to predict earlier recurrence. Prognostic biomarkers are needed to predict outcomes and facilitate patient management.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055931","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":"The role of fusion-targeted prostate biopsy in clinically significant prostate cancer detection in elusive small-diameter lesions in high-volume prostates: Comparison of cognitive and fusion-targeted techniques.","authors":"Cagri Akpinar, Digdem Kuru Oz, Eriz Ozden, Nuray Haliloglu, Basak Gulpinar, Muhammed Arif Ibis, Muratcan Karaburun, Mehmet Fatih Ozkaya, Efe Turgut, Omer Gulpinar, Mehmet Ilker Gokce, Evren Suer, Sumer Baltaci","doi":"10.1016/j.urolonc.2025.08.011","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.08.011","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether fusion biopsy provides an advantage in detecting clinically significant prostate cancer(csPCa) in elusive small-diameter lesions, especially in high volume prostates.</p><p><strong>Material and methods: </strong>Data of 762 patients who underwent multiparametric magnetic resonance imaging(mpMRI) before prostate biopsy at single center between January 2017 and January 2024 were retrospectively assessed. All of these patients underwent combined cognitive and fusion targeted biopsy and systematic biopsy of suspicious lesions and transrectal ultrasonography guided systematic biopsy by 2 separate experienced radiologists(with histopathological evaluation completed for all specimens). Lesions were categorized by diameter (≤5 mm, 6-10 mm, >10 mm) and prostate volumes (≤30 mL, 31-70 mL, >70 mL). (All patients underwent 3T mpMRI, and lesions were scored using PI-RADS v2.1. The largest lesion with the highest PI-RADS score was considered the index lesion.) RESULTS: Patient characteristics, including clinical and radiological features, were balanced between cognitive and fusion biopsy groups. PI-RADS stratification showed similar detection rates for PI-RADS 3, 4 and 5 lesions between methods. For lesions ≤5 mm, fusion biopsy showed a significantly higher csPCa detection rate than cognitive biopsy (16.4% vs. 3%, P = 0.033). No clinical significant prostate cancer was detected in lesions ≤5 mm with prostate volumes >30 ml in cognitive biopsy group. For lesions 6-10 mm and >10 mm, detection rates were comparable between procedures.</p><p><strong>Conclusion: </strong>MRI Fusion-targeted biopsy is particularly advantageous for smaller lesions and in settings where precise lesion targeting is critical. However, for larger lesions or institutions with skilled operators, cognitive-targeted biopsy remains a viable and effective alternative.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041514","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":"Metastasectomy outcomes in renal cell carcinoma: insights from hereditary leiomyomatosis and succinate dehydrogenase deficient cohorts.","authors":"Milan H Patel, Ruben Blachman-Braun, Braden Millan, Lauren Loebach, Jaskirat Saini, Ramaprasad Srinivasan, Gabriela Bravo Montenegro, Sandeep Gurram, W Marston Linehan, Mark W Ball","doi":"10.1016/j.urolonc.2025.07.021","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.021","url":null,"abstract":"<p><strong>Background and objective: </strong>Metastatic hereditary leiomyomatosis renal cell cancer (HLRCC)-associated and succinate dehydrogenase-deficient (SDH-deficient) renal cell carcinoma (RCC) have aggressive oncological behavior. Thus, in this study we aimed to describe our experience with patients diagnosed with metastatic HLRCC-associated and SDH-deficient RCC who underwent surgical metastasectomy (SM).</p><p><strong>Materials and methods: </strong>A retrospective study was conducted selecting patients with either germline variant confirmed HLRCC-associated or SDH-deficient RCC who underwent SM at our institution between 2002 and 2024. Clinical and oncological variables were analyzed. Kaplan-Meier analysis was used to estimate the median (95% confidence interval; CI) systemic therapy-free survival, time to subsequent SM, and overall survival (OS) following the initial SM.</p><p><strong>Results: </strong>A total of 23 patients were identified; 17 (73.9%) had HLRCC-associated, and 6 (26.1%) had SDH-deficient RCC. The age at index renal surgery was 35 [24-47] years, and 38.6 years [27-52.4] at first SM. The median systemic therapy-free survival following initial SM was 2.58 years (95% CI: 0.31-4.86), and OS following initial SM was 8.17 years (95% CI: 2.94-13.39). At 1, 3, and 5 years after SM, 55%, 32%, and 32% of the patients, respectively, had not received systemic therapy. The OS at 3, 5, and 10 years after initial SM was 72%, 53%, and 40%, respectively.</p><p><strong>Conclusions: </strong>SM in well-selected patients with metastatic HLRCC-associated and SDH-deficient RCC offers favorable oncologic outcomes and over 2 years of systemic therapy-free survival. This surgical approach should be carefully considered within a multidisciplinary setting, emphasizing thorough patient selection.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041374","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}