Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Morbidity and mortality of salvage radical prostatectomy for prostate cancer: An analysis of the National surgical quality improvement program targeted prostatectomy database.","authors":"Vatsala Mundra, Renil Sinu Titus, Eusebio Luna, Jiaqiong Xu, Carlos Riveros, Sanjana Ranganathan, Brian Miles, Dharam Kaushik, Christopher J D Wallis, Raj Satkunasivam","doi":"10.1016/j.urolonc.2025.07.019","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.019","url":null,"abstract":"<p><strong>Introduction/background: </strong>For men with local recurrence of prostate cancer following radiotherapy, salvage radical prostatectomy (SRP) may be considered. However, SRP is associated with increased risk of surgical complications and patient selection is critical. To quantify this contemporary risk and identify predictive factors, we performed a retrospective cohort study utilizing the NSQIP targeted radical prostatectomy (RP) dataset.</p><p><strong>Methods: </strong>We identified adult patients undergoing robotic-assisted RP from 2019 to 2022 using the NSQIP database. The primary outcome was the rates of procedure-specific outcomes such as rectal injury, urinary leak or fistula, gastrointestinal (GI) leak/injury, prolonged postoperative nil per os (NPO) or nasogastric tube (NGT) use, and development of lymphoceles. Secondary outcomes included major postoperative outcomes. RP and SRP groups were balanced using propensity score matching.</p><p><strong>Results: </strong>Among 27,280 patients, SRP was associated with an increased risk of urinary leak or fistula (OR 3.94, 95% CI 1.85-8.39), GI injury (OR 1.80, 95% CI 1.09-2.98) and prolonged postoperative NPO or NG tube use (OR 5.15, 95% CI 2.24-11.83). SRP was associated with higher surgical site infections (SSI) (OR 3.17, 95% CI 1.60-6.30) and unplanned readmission (OR 2.43, 95% CI 1.33-4.44). Subgroup analysis identified an increased risk of urinary leak associated with SRP in those with a BMI >25 and age ≥65.</p><p><strong>Conclusion: </strong>SRP was associated with a 3-fold risk of SSI, 3-fold risk of leak/fistula and a 2-fold risk of unplanned readmission. Obese and elderly patients were more likely to experience urinary leak. These data can be used to optimize patients and select those who will benefit from SRP.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970841","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 endoscopic management for upper tract urothelial carcinoma: A multi-center international cohort analysis.","authors":"Jaime O Herrera-Caceres, Marian Wettstein, Surena F Matin, Craig Labbate, Aaron Potretzke, Rodrigo Rodriguez, Nirmish Singla, Maximilian Pallauf, William Huang, Shavy Nagpal, Nir Kleinmann, Asaf Shvero, Alexander Small, Benjamin Green, Jennifer Linehan, Jane Choe, Ojas Shah, Arun Rai, Hristos Kaimakliotis, Isamu Tachibana, David Canes, Aaron Perecman, Jay D Raman","doi":"10.1016/j.urolonc.2025.07.015","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.015","url":null,"abstract":"<p><strong>Introduction: </strong>Upper tract urothelial carcinoma (UTUC) is a rare and aggressive malignancy with significant morbidity, often requiring radical nephroureterectomy (RNU) as the standard of care. Endoscopic ablation has emerged as a kidney-sparing alternative, particularly for low-risk UTUC. Given the rarity of UTUC, generating high-quality evidence for treatment strategies remains challenging. This study presents a large, multi-institutional analysis of outcomes following primary endoscopic ablation for UTUC.</p><p><strong>Methods: </strong>A retrospective analysis of 432 patients across 11 institutions who underwent first-time endoscopic treatment for UTUC with curative intent between December 2003 and January 2023 was performed. Baseline demographics, tumor characteristics, and procedural details were collected. Recurrence was categorized as ipsilateral, distant, or bladder recurrence, with overall survival (OS) as the primary outcome. Univariate and multivariate Cox regression models were used to identify predictors of recurrence and survival.</p><p><strong>Results: </strong>At a median follow-up of 21 months, ipsilateral recurrence occurred in 232 patients (54%), while 55 (13%) developed distant metastases. The OS rate was 86%, with 29 patients (6.7%) dying within the first 12 months. On univariate analysis, the presence of a tumor not involving the renal pelvis (HR 0.71, P = 0.04) and use of a ureteral access sheath (UAS) (HR 0.65, P = 0.03) were associated with lower ipsilateral recurrence rates. On multivariate analysis, only UAS use remained significant (HR 0.39, P < 0.01). High-grade tumors were significantly associated with poorer OS (HR 3.59, P < 0.01).</p><p><strong>Conclusions: </strong>Endoscopic ablation is a feasible kidney-sparing alternative for UTUC. Ipsilateral recurrence rate is approximately 50% with over 10% of patients developing metastatic disease. UAS use may reduce UTUC recurrence risk.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970881","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":"Advancing age- and gender-sensitive supportive care and follow-up strategies in bladder cancer.","authors":"Alessio Rizzo, Antonio Valenti","doi":"10.1016/j.urolonc.2025.07.031","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.031","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970765","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":"Renal surgery following HIF-2α antagonist therapy: Surgical indications, outcomes and growth kinetics.","authors":"Daniel Nethala, Braden Millan, Jason Hyman, Nityam Rathi, Jessica Hsueh, Christopher Koller, Charles Hesswani, Alexander P Kenigsberg, Neil Mendhiratta, Keith Lawson, Matthew Miller, Sahil Parikh, William Azar, Kyle Schuppe, Maria J Merino, Cathy D Vocke, Christopher J Ricketts, Ramaprasad Srinivasan, Sandeep Gurram, W Marston Linehan, Mark W Ball","doi":"10.1016/j.urolonc.2025.06.015","DOIUrl":"10.1016/j.urolonc.2025.06.015","url":null,"abstract":"<p><strong>Background: </strong>The development of HIF-2α antagonists marked an advancement in the treatment of localized VHL-deficient kidney cancer; however, their impact on subsequent surgical interventions remains unexplored. This study investigated the indications for and outcomes of patients undergoing renal surgery after exposure to HIF-2α antagonists and the growth rates (GR) of their index renal tumors.</p><p><strong>Design, setting, and participants: </strong>We performed a retrospective analysis of patients who underwent renal surgery at a single institution following or during treatment with a HIF-2α antagonist. Data regarding the clinicopathologic characteristics, therapy management, and surgical outcomes were collected. Index tumor GRs before, during and after drug administration were calculated and compared.</p><p><strong>Results and limitations: </strong>Twenty-seven patients underwent 28 surgeries after exposure to a HIF-2α antagonist from 2015 to 2023, with a total of 82 tumors removed. About 24 patients were treated with Belzutifan, and 3 patients were treated with PT2385, with 26 patients having a diagnosis of VHL syndrome. The median time on therapy prior to surgery was 14.7 months, with a median washout time of drug to surgery of 10 days. Median preoperative hemoglobin prior to surgery was 11.6 g/dL. Two blood transfusions were administered, 1 intraoperatively and 1 postoperatively. Seven postoperative complications were noted, 2 of which were ≥ Grade 3. The median index tumor GR prior to treatment was 0.37 cm/y, 0.46 cm/y during treatment, and 0.54 cm/y post-treatment. There was no significant difference in GRs between the groups. Median time to restart HIF-2α antagonist after surgery was 43 days. Limitations of this study include retrospective nature, single center, and lack of control group.</p><p><strong>Conclusions: </strong>Renal surgery after or during exposure to a HIF-2α antagonist is safe and feasible, with rates of both transfusions and complications commensurate with the reported literature from standard renal surgery. GRs of index renal tumors that eventually needed surgical intervention did not show a significant difference before, during, and after therapy. Tumors exhibiting a positive GR on drug may represent the indication that drives early surgical intervention prior to the tumor reaching the 3 cm threshold. A median washout time of 10 days from last dose of HIF-2α antagonist to surgery was safe and well tolerated.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted partial nephrectomy with the Hugo™ RAS system: Perioperative outcomes from a single-center cohort including moderate-to-highly complex renal masses.","authors":"Francesco Prata, Salvatore Basile, Francesco Tedesco, Alberto Ragusa, Andrea Iannuzzi, Alessandro De Giuseppe, Marco Ricci, Pasquale Callè, Valeriu Rosca, Alfredo Travino, Angelo Civitella, Rocco Papalia","doi":"10.1016/j.urolonc.2025.07.023","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.023","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the perioperative and early functional outcomes of robot-assisted partial nephrectomy (RAPN) using the Hugo™ RAS System in a consecutive single-center cohort of patients, including a subgroup of moderate-to-high complexity renal masses.</p><p><strong>Methods: </strong>We retrospectively analyzed 80 consecutive patients who underwent off-clamp RAPN with the Hugo™ RAS System between October 2022 and October 2024. Tumor complexity was evaluated using the R.E.N.A.L. nephrometry score. Perioperative variables, pathological data, and renal function were collected. The primary endpoint was to explore the safety and feasibility of the Hugo™ RAS System in nephron-sparing surgery. Trifecta achievement was defined as negative surgical margins, no Clavien-Dindo ≥IIIa complications, and ≤30% eGFR decline at discharge.</p><p><strong>Results: </strong>The cohort included 53 males and 27 females, with a median age of 63 years. Median tumor size was 32.5 mm at CT scan; 70% of tumors were classified as cT1a while 36 patients had moderate (score 7-9) or highly complex (score ≥10) renal masses. Median operative time was 105.5 minutes, docking time 4 minutes, console time 53 minutes, and estimated blood loss 200 mL. No conversions or major intraoperative complications were recorded. Overall complication rate was 15%, with 1.3% major complications. Negative surgical margins were obtained in 96.2% of cases. Median eGFR at discharge was comparable to baseline (P = 0.65). Trifecta was achieved in 78.8% of the full cohort.</p><p><strong>Conclusions: </strong>RAPN using the Hugo™ RAS System is a feasible and safe option for the management of renal masses, including complex cases. The platform demonstrated preliminary favorable perioperative outcomes, low complication rates, and satisfactory preservation of renal function even in a moderate-to-highly complex setting.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970684","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 the preoperative modified 5-item frailty index on the efficacy of neoadjuvant chemotherapy in patients with muscle invasive bladder cancer.","authors":"Keisuke Goto, Yuki Kohada, Kohei Kobatake, Ryo Tasaka, Hideo Iwamoto, Takeshi Ueno, Akira Fujita, Tomoki Furutani, Kunihiro Hashimoto, Yoshimasa Kurimura, Kosuke Akiyama, Kensuke Nishida, Tetsutaro Hayashi, Nobuyuki Hinata","doi":"10.1016/j.urolonc.2025.07.029","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.029","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to determine the optimal treatment strategy for MIBC patients undergoing neoadjuvant chemotherapy (NAC) followed by radical cystectomy. We investigated whether preoperative frailty influences the efficacy of NAC by evaluating the Modified 5-item Frailty Index (mFI-5), which was developed as a comprehensive geriatric evaluation tool with a reduced number of variables to simplify data collection.</p><p><strong>Methods: </strong>This retrospective study included 356 MIBC patients. Clinical information was collected retrospectively from medical records. Preoperative frailty was evaluated according to the mFI-5 score, and associations between NAC and clinical outcomes were investigated. Overall survival (OS) was evaluated by the Kaplan-Meier method and a Cox proportional hazard model.</p><p><strong>Results: </strong>Patients who received NAC had significantly lower mFI-5 scores (P = 0.021) than those who did not. Although the preoperative mFI-5 score had a minor impact on other clinicopathological parameters, a significant difference in OS was found between patients mFI-5-low and mFI-5-high groups (P = 0.036). Furthermore, NAC significantly improved OS, especially in patients in the mFI-5-low group (P = 0.007), whereas no significant difference was found in patients in the mFI-5-high group. In patients who received NAC, the eGFR (HR=2.12, P = 0.024), pT stage (HR=2.29, P = 0.017), pN stage (HR=2.14, P = 0.044), and mFI-5 score (HR=2.23, P = 0.020) were independent predictors of OS.</p><p><strong>Conclusion: </strong>In patients who received NAC, the preoperative mFI-5 score and renal function were significantly associated with OS. Preoperative frailty, as evaluated by the mFI-5, might be an important factor for determining the indications for NAC in MIBC patients.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970809","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":"KDM6A deficiency promotes 5-aminolevulinic acid-mediated photodynamic therapy resistance in bladder cancer by suppressing ROS accumulation.","authors":"Ryo Tasaka, Kohei Kobatake, Yuki Kohada, Kenshiro Takemoto, Takafumi Fukushima, Kento Miura, Ryoken Yamanaka, Takashi Babasaki, Yohei Sekino, Hiroyuki Kitano, Keisuke Goto, Akihiro Goriki, Keisuke Hieda, Osamu Kaminuma, Nobuyuki Hinata","doi":"10.1016/j.urolonc.2025.07.022","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.022","url":null,"abstract":"<p><strong>Background: </strong>Non-muscle invasive bladder cancer (NMIBC) frequently recurs after transurethral resection of bladder tumors, necessitating a novel therapeutic approach. 5-Aminolevulinic acid-based photodynamic therapy (ALA-PDT) has emerged as a minimally invasive therapeutic approach; however, its long-term efficacy remains limited, and the mechanisms underlying ALA-PDT resistance are unclear. Lysine-specific demethylase (KDM) 6A, a tumor suppressor frequently mutated in NMIBC, has been implicated in cancer stemness and therapy resistance.</p><p><strong>Objective: </strong>This study aimed to investigate the role of KDM6A deficiency in modulating ALA-PDT efficacy in bladder cancer.</p><p><strong>Methods: </strong>KDM6A-knockout (KO) bladder cancer cell lines were established using CRISPR/Cas9-based gene editing. Cancer stemness was evaluated via sphere formation assays and expression of stem cell markers, while the cytotoxic effects of ALA-PDT were assessed through cell viability analysis. Protoporphyrin IX (PpIX) accumulation and reactive oxygen species (ROS) generation were examined using fluorescence microscopy and flow cytometry.</p><p><strong>Results: </strong>KDM6A-KO cells exhibited significantly increased sphere-forming ability, enhanced stem cell marker expression, and greater resistance to ALA-PDT-induced cytotoxicity. Despite elevated PpIX accumulation in KDM6A-KO cells, ROS levels following ALA-PDT were significantly reduced. A negative correlation between KDM6A expression and ROS-scavenging enzymes expression, particularly SOD2 and GPX1, was confirmed both in public database analyses and in KDM6A-deficient cells.</p><p><strong>Conclusions: </strong>These findings indicate that KDM6A deficiency promotes cancer stemness and confers resistance to ALA-PDT in bladder cancer cells by suppressing ROS generation despite increased PpIX levels. This study provides new insights into the role of KDM6A in ALA-PDT resistance and may contribute to developing novel therapeutic and diagnostic strategies for NMIBC.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970776","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":"Evaluating surrogates for overall survival in the adjuvant treatment of bladder cancer with chemotherapy","authors":"C.N. Sternberg M.D. ,&nbsp;P. Squifflet M.Sc. ,&nbsp;E.D. Saad M.D. ,&nbsp;S. Burdett M.Sc. ,&nbsp;D. Fisher M.Sc. ,&nbsp;M. Kurt Ph.D. ,&nbsp;S. Teitsson M.Sc. ,&nbsp;J.R. May Ph.D. ,&nbsp;M.Y. Patel PharmD ,&nbsp;M. Stoeckle M.D. ,&nbsp;F. Torti M.D. ,&nbsp;R. Cote M.D. ,&nbsp;E.M. Ruggeri M.D. ,&nbsp;A. Zhegalik M.D. ,&nbsp;J.F. Tierney Ph.D. ,&nbsp;L. Collette Ph.D. ,&nbsp;T. Burzykowski Ph.D. ,&nbsp;M. Buyse Sc.D.","doi":"10.1016/j.urolonc.2025.07.013","DOIUrl":"10.1016/j.urolonc.2025.07.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Surrogates for overall survival (OS) can expedite the development of adjuvant treatments for bladder cancer. We evaluated whether disease-free survival (DFS) or distant metastasis-free survival (DMFS) are valid surrogates for OS in patients with muscle-invasive disease treated with cisplatin-based chemotherapy after radical cystectomy.</div></div><div><h3>Methods</h3><div>We analyzed individual patient data from 1075 patients enrolled in 9 randomized controlled trials (RCTs) identified by systematic review. These RCTs compared adjuvant cisplatin-based chemotherapy combined with local treatment versus local treatment alone and excluded neoadjuvant chemotherapy. We measured the patient-level association between DFS/DMFS and OS using Spearman’s correlation coefficient (ρ), and the trial-level association between hazard ratios (HRs) using R². For both measures, values close to 1.00 are required for surrogate validation. We assessed the intent-to-treat (ITT) populations and subgroups defined by lymph node status.</div></div><div><h3>Results</h3><div>The evaluation of DFS in the ITT population showed ρ = 0.89 (95% confidence interval [CI] 0.87–0.90) and R² = 0.69 (95% CI, 0.34–1.00). Corresponding measures for DMFS were ρ = 0.91 (95% CI, 0.89–0.92) and R² = 0.90 (95% CI, 0.74–1.00). Patient-level associations were moderate or strong regardless of the lymph node status. At the trial level, DFS displayed weak association with OS in lymph node–positive patients, but associations were strong for lymph node–negative patients and for DMFS.</div></div><div><h3>Conclusion</h3><div>In the adjuvant treatment of bladder cancer with cisplatin-based chemotherapy, DFS is a moderate to strong surrogate for OS, while DMFS is a strong surrogate for OS.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 11","pages":"Pages 661.e9-661.e17"},"PeriodicalIF":2.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970778","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":"Risk of de novo prostate cancer diagnosis after solid organ transplant: A retrospective claims-based matched cohort study","authors":"Aurora J. Grutman M.P.H ,&nbsp;Mark N. Alshak M.D. ,&nbsp;Isabella Florissi M.D. ,&nbsp;Michelle I. Higgins M.D. ,&nbsp;Yuezhou Jing M.A., M.S. ,&nbsp;Christian P. Pavlovich M.D.","doi":"10.1016/j.urolonc.2025.07.026","DOIUrl":"10.1016/j.urolonc.2025.07.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Immunosuppression in solid organ transplant patients raises concerns for de novo cancer development. However, research has been limited by small sample sizes or lack of matching. This study used a claims database to assess risk of prostate cancer in transplant patients compared to the general population.</div></div><div><h3>Methods</h3><div>The TriNetX Research Network was queried for men without history of prostate cancer who underwent solid organ transplant (kidney, heart/lung, liver, or pancreas) between ages 50–59, 60–69, and 70–79. Transplant patients were matched by age and PSA-screening to controls who did not have a history of solid organ transplant or prostate cancer.</div></div><div><h3>Results</h3><div>After matching, there were 59,701 patients in each arm for the 50–59 cohort, 66,801 per arm for the 60-69 cohort, and 34,187 per arm for the 70–79 cohort. For all 3 transplant cohorts, the relative risk of a prostate cancer diagnosis was significantly lower than for their age-matched controls through 10 years after solid organ transplant. When stratified by organ type, men with kidney or liver transplants had a lower risk of prostate cancer compared to controls. Men with heart/lungs or pancreas transplants had risk similar to controls.</div></div><div><h3>Conclusions</h3><div>The decreased long-term risk of a prostate cancer diagnosis in transplant patients compared to matched controls highlights the likely value of pretransplant PSA screening and the lack of any clearly increased prostate cancer risk related to immunosuppressive medication in this population. Additional studies are needed to clarify any relationship between prostate cancer and transplantation and post-transplant screening recommendations.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 11","pages":"Pages 664.e19-664.e26"},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970720","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":"Assessing pentafecta achievement and survival of retroperitoneal robotic partial nephrectomy for anterior tumors: An update on the outcomes of a long-term follow-up.","authors":"Chao Zhang, Jun Du, Wenfeng Liao, Xinxin Duan, Lei Diao, Zhenting Zhang, Xusheng Chen, Qing Yang, Xin Yao","doi":"10.1016/j.urolonc.2025.07.027","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.07.027","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the perioperative, functional and oncological results of retroperitoneal robotic-assisted laparoscopic partial nephrectomy (rRAPN) and transperitoneal robotic-assisted laparoscopic partial nephrectomy (tRAPN) for anterior renal masses.</p><p><strong>Methods: </strong>The charts of patients with anterior renal mass from February 2016 to December 2023 undergoing robotic-assisted laparoscopic partial nephrectomy (RAPN) were reviewed. Parameters including demographic characteristics, as well as perioperative, functional and oncological outcomes were analyzed. Univariable and multivariable logistic regression analyses were applied to explore the indicators for postoperative pentafecta achievement.</p><p><strong>Results: </strong>After propensity score matching, each group recruited 98 cases. Radius, Exophytic/endophytic, Nearness, Anterior/posterior, Location (R.E.N.A.L.) scores of all matched tumors were low or moderately complex (R.E.N.A.L. score ≤9). Demographic characteristics, histopathological data, perioperative and postoperative parameters were similar other than shorter operative time (OT; P = 0.018), less estimated blood loss (EBL; P = 0.031), earlier first anal exhaust (P < 0.001) and reduced postoperative length of stay (PLOS, P = 0.039) in the rRAPN group. With median follow-up durations of 55.2 months in the rRAPN group and 54.9 months in the tRAPN group (P = 0.711), no significant differences were observed in progression-free survival (P = 0.741), cancer-specific survival (P = 0.324), or overall survival (P = 0.549). Pentafecta achievement rates of rRAPN and tRAPN were similar and good (58.2% vs. 55.1%, P = 0.773). Multivariable analysis revealed that R.E.N.A.L. score (P = 0.002) but not surgical approach (P = 0.571) was the risk factor associated with pentafecta achievement.</p><p><strong>Conclusions: </strong>For anterior renal tumors of low or moderate complexity, both rRAPN and tRAPN provide robust and comparable results in terms of pentafecta achievement and oncological outcomes. The retroperitoneal approach offers shorter OT, less EBL, earlier first anal exhaust and reduced PLOS, which may suggest that rRAPN is an effective approach for selected anterior renal masses.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970797","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}