Urologic Oncology-seminars and Original Investigations最新文献

{"title":"The predictive value of lesion density in enhancing multiparametric MRI for detecting clinically significant prostate cancer","authors":"Ali Khatib M.D., M.Sc. ,&nbsp;Zizo Al-Daqqaq M.D. ,&nbsp;Anna J. Black M.D. ,&nbsp;Silvia Chang M.D. ,&nbsp;Martin E Gleave M.D. ,&nbsp;Miles P. Mannas M.D., M.Sc.","doi":"10.1016/j.urolonc.2025.12.017","DOIUrl":"10.1016/j.urolonc.2025.12.017","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to evaluate the predictive value of lesion density on mpMRI for detecting clinically significant prostate cancer (csPCa) in men undergoing targeted prostate biopsy.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients who underwent MRI-targeted transperineal or transrectal biopsy between 2019 and 2023. Lesion density was calculated as longest lesion diameter divided by prostate volume, with weighted averages used for multiple lesions. Multivariable logistic regression and receiver operating characteristic (ROC) analysis assessed predictors of csPCa. Threshold analysis evaluated trade-offs between missed csPCa and avoided biopsies.</div></div><div><h3>Results</h3><div>csPCa was diagnosed in 241/460 patients (52.4%). Median lesion density was higher in csPCa vs. non-csPCa cases (0.34 mm/cc, IQR 0.22–0.52 vs. 0.22 mm/cc, IQR 0.14–0.33; <em>P</em> &lt; 0.001). Lesion density was independently predictive in models with (OR 6.2, 95% CI 1.4–27.9) and without PI-RADS (OR 13.7, 95% CI 3.2–59.0). It achieved the highest AUC (0.71) compared with PSA density (0.69) and age (0.63). At a lesion density threshold of 0.15 mm/cc, 29.2% of biopsies would have been avoided with &lt;10% missed csPCa.</div></div><div><h3>Conclusion</h3><div>Lesion density was an independent predictor of csPCa on targeted biopsy. It may complement PI-RADS and PSA density and provide a pragmatic threshold-based tool to guide biopsy decision-making.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110981"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079592","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":"Optimizing oncological outcomes in high-grade non-muscle invasive bladder cancer: The impact of a surgeon-led treatment pathway","authors":"Pietro Scilipoti M.D. ,&nbsp;Giuseppe Rosiello M.D. ,&nbsp;Alfonso Santangelo M.D. ,&nbsp;Alessandro Viti M.D. ,&nbsp;Mattia Longoni M.D. ,&nbsp;Angelo Occhi M.D. ,&nbsp;Michele Brancaccio M.D. ,&nbsp;Giovanni Tremolada M.D. ,&nbsp;Andrea Folcia M.D. ,&nbsp;Paolo Zaurito M.D. ,&nbsp;Mario de Angelis M.D. ,&nbsp;Pierre I. Karakiewicz M.D. ,&nbsp;Alexandre Mottrie M.D., Ph.D. ,&nbsp;Roberta Lucianò M.D. ,&nbsp;Maurizio Colecchia M.D. ,&nbsp;Andrea Salonia M.D., Ph.D. ,&nbsp;Alberto Briganti M.D., Ph.D. ,&nbsp;Marco Moschini M.D., Ph.D. ,&nbsp;Francesco Montorsi M.D.","doi":"10.1016/j.urolonc.2026.111007","DOIUrl":"10.1016/j.urolonc.2026.111007","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of high-grade non-muscle invasive bladder cancer (HG-NMIBC) is complex, requiring accurate transurethral resection of bladder tumors (TURBT), intravesical therapy, and diligent follow-up. We hypothesized that centralizing patient care from the first diagnosis could improve oncological outcomes in these patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 175 consecutive patients with HG-NMIBC who underwent TURBT performed by a highly experienced surgeon at a tertiary referral center (2012–2023). All specimens were reviewed by 2 experienced uropathologists, and all patients received <em>Bacillus</em> Calmette-Guérin (BCG). Group A included patients treated solely by the experienced surgeon, while Group B consisted of patients initially treated elsewhere before undergoing TURBT at our center. Propensity score-based overlap weighting was applied to balance the groups. Kaplan-Meier curves and weighted univariable Cox regression models were used to estimate disease-free survival (DFS, defined as recurrence or progression), progression-free survival (PFS), and cancer-specific survival (CSS).</div></div><div><h3>Results</h3><div>Group A included 94 (54%) patients, while Group B 81 (46%) patients. Median age was 71 years. T1HG disease was present in 126 (72%) patients and was equally distributed (<em>P</em> = 0.7). Early epirubicin instillation (EI) was given to 52% in Group A and 37% in Group B (<em>P</em> = 0.045). pT0 rate at re-TURBT was 59% in Group A vs. 36% in Group B (<em>P</em> = 0.025), with HG disease in 31% and 52% (<em>P</em> = 0.027), respectively. The 5-year DFS was 75% in Group A and 51% in Group B (HR:0.36, <em>P</em> &lt; 0.001). Group A had better PFS (HR:0.31, <em>P</em> = 0.011) and CSS (HR:0.36, <em>P</em> = 0.023). After weighting, DFS (HR:0.47, <em>P</em> = 0.014), PFS (HR:0.38, <em>P</em> = 0.034), and CSS (HR:0.25, <em>P</em> = 0.002) remained significant. Overall, 21 (12%) patients underwent radical cystectomy.</div></div><div><h3>Conclusions</h3><div>In this single-center cohort of HG-NMIBC managed within a structured, surgeon-led pathway at a tertiary referral center, long-term disease control rates were highly favorable. Surgeon experience from first diagnosis, adherence to surgical protocols, intravesical therapy, and follow-up are crucial for improving oncological outcomes in HG-NMIBC patients.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 111007"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173860","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":"Adapting patient priorities care for older adults with non-muscle-invasive bladder cancer: A qualitative inquiry","authors":"Tullika Garg ,&nbsp;Steven Negron-Candelario ,&nbsp;Halle Miller ,&nbsp;Seyma Demirsoy ,&nbsp;Kirstin West ,&nbsp;William Calo ,&nbsp;Mary Tinetti ,&nbsp;Lauren J. Van Scoy","doi":"10.1016/j.urolonc.2026.110996","DOIUrl":"10.1016/j.urolonc.2026.110996","url":null,"abstract":"<div><h3>Introduction</h3><div>Shared decision-making involves understanding a person’s goals and healthcare preferences, especially for older adults with cancer. When making treatment decisions, older adults with non-muscle-invasive bladder cancer (NMIBC) face tradeoffs due to aging and multimorbidity. Our objective was to obtain initial feedback from older adults with NMIBC and their urologists to begin adapting an existing written goal-elicitation tool, Patient Priorities Care (PPC), for shared decision-making in NMIBC.</div></div><div><h3>Methods</h3><div>We recruited 5 dyads of older adults with NMIBC (age ≥65) paired with their urologists to use PPC and collected demographics. Patients also completed a frailty assessment. Qualitative interviews with participants were conducted to assess modifications needed (<em>n</em> = 10). We calculated descriptive statistics of quantitative data and used Braun and Clarke’s six-phase framework and Interpretative Phenomenological Analysis to analyze interview transcripts.</div></div><div><h3>Results</h3><div>Mean patient age was 76.4 years, and all were males and frail. Urologists had been in practice for an average of 14.8 years. Four themes emerged from the interviews: 1) PPC should be administered periprocedurally and at multiple time points, 2) PPC was appropriate but modifications were needed to the format and to make it specific to NMIBC, 3) PPC helped urologists learn about their patients, and 4) age, multimorbidity, and urinary symptoms contributed to NMIBC treatment decisions.</div></div><div><h3>Conclusions</h3><div>In this pilot qualitative study, participants found PPC easy to use with appropriate content, but it required modifications for format and specificity for NMIBC. Next steps include focus groups to further adapt PPC followed by feasibility testing in the clinic.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110996"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137831","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":"Lack of survival benefit of pelvic lymph node dissection for patients with radical prostatectomy and postprostatectomy radiotherapy","authors":"Isaac E. Kim Jr. M.D., Ph.D. ,&nbsp;Dhruv Puri M.D. ,&nbsp;Nityam Rathi M.D., M.S. ,&nbsp;Michael S. Leapman M.D., M.H.S. ,&nbsp;Isaac Y. Kim M.D., Ph.D., M.B.A.","doi":"10.1016/j.urolonc.2025.110985","DOIUrl":"10.1016/j.urolonc.2025.110985","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>The survival benefit of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) remains unclear. Recent guidelines suggest that PLND may be therapeutic in subsets of patients with limited nodal disease, however, differences in outcome could be obscured by subsequent therapy. Thus, the objective of this study was to evaluate the association between PLND and extent of nodal resection and overall survival (OS) among patients treated with RP and postprostatectomy radiotherapy.</div></div><div><h3>Materials and methods</h3><div>Using the National Cancer Database (NCDB), we examined the association between OS and PLND status among patients diagnosed with prostate cancer from 2012 to 2021 who underwent RP with postprostatectomy radiotherapy. Propensity score matching (PSM) was performed based on pathologic T stage, age, PSA, race, hormonal therapy, and the number of nodes examined. We then compared the OS of patients who did and did not undergo pelvic lymph node dissection (PLND) as well as the extent of PLND (1-9 nodes vs. 10+ nodes and 1-14 nodes vs. 15+ nodes thresholds) stratified by National Comprehensive Cancer Network (NCCN) risk group.</div></div><div><h3>Results</h3><div>Of 28946 patients treated with RP who later underwent post-RP radiotherapy, 4254 were selected for the matched cohort (2127 PLND and 2127 non-PLND). There was no significant OS difference between PLND and non-PLND patients both overall (<em>P</em> = 0.74) and across all risk groups (low: <em>P</em> = 0.73, intermediate: <em>P</em> = 0.70, high: <em>P</em> = 0.60). There were also no significant OS differences between 1 and 9 node PLND and more extensive 10+ node PLND patients overall and across all risk groups. Patients who received 15+ node PLND had lower Charlson-Deyo scores than those who did not receive a PLND. Thus, while high-risk patients who received a 15+ node PLND did experience initial improved OS compared to those who underwent 1-14 node PLND (baseline aHR 0.52, 95% CI, 0.30-0.92, <em>P</em> = 0.02) and no PLND (baHR 0.35, 95% CI, 0.13-0.95, <em>P</em> = 0.04), a subset analysis of high-risk patients with Charlson-Deyo score of 0 found no survival differences in 1-14 node and 15+ node PLND patients when compared to non-PLND (1-14 node PLND: aHR 0.81, 95% CI, 0.54-1.21, <em>P</em> = 0.31; 15+ node PLND: aHR 0.97, 95% CI, 0.47-1.98, <em>P</em> = 0.93).</div></div><div><h3>Conclusions</h3><div>Among RP patients receiving post-RP radiotherapy, there were no OS differences between patients who received no PLND and PLND as well as between non-PLND, 1-14 node PLND, and 15+ node PLND patients when controlling for Charlson-Deyo comorbidity. These findings suggest that PLND may not be associated with a long-term OS benefit for patients undergoing prostatectomy and post-RP radiotherapy.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110985"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025453","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":"Pharmacologic synergy versus independent action in androgen receptor-axis-targeted agent-docetaxel triplet therapy for metastatic hormone-sensitive prostate cancer: a copula-based analysis","authors":"Wei Chen M.D. ,&nbsp;Soichiro Yoshida M.D., Ph.D. ,&nbsp;Shugo Yajima M.D. ,&nbsp;Hiroyuki Sato Ph.D. ,&nbsp;Akihiro Hirakawa Ph.D. ,&nbsp;Kenji Tanabe M.D. ,&nbsp;Hiroshi Fukushima M.D., Ph.D. ,&nbsp;Yosuke Yasuda M.D., Ph.D. ,&nbsp;Hajime Tanaka M.D., Ph.D. ,&nbsp;Hitoshi Masuda M.D., Ph.D. ,&nbsp;Yasuhisa Fujii M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.110990","DOIUrl":"10.1016/j.urolonc.2025.110990","url":null,"abstract":"<div><h3>Background</h3><div>Triplet therapy combining androgen deprivation therapy (ADT), docetaxel, and androgen receptor-axis-targeted agents (ARATs) has exhibited survival benefits in metastatic hormone-sensitive prostate cancer (mHSPC). Whether these benefits originate from pharmacologic synergy or independent drug action (IDA) remains unclear.</div></div><div><h3>Methods</h3><div>Using reconstructed individual patient data from phase III trials, we applied a copula-based independent-action model to compare observed triplet outcomes with counterfactual predictions derived from docetaxel- and ARAT-based doublets. The primary analysis used weak positive dependence (θ = 0.24), with sensitivity analyses across a plausible range.</div></div><div><h3>Results</h3><div>The triplet, docetaxel-doublet, and ARAT-doublet cohorts comprised 138/355, 206/355, and 637/1,667 events/patients for rPFS, respectively. The observed triplet outcomes did not exceed independent-action predictions (observed/predicted Hazard ration [HR] 1.39; 95% Confidence Interval [95% CI] 1.12–1.74), with excellent concordance in curve shape (<em>r</em> = 0.99) and a difference of restricted mean survival time (ΔRMST) of 4.47 months favoring the prediction. Drug-matched analyses using abiraterone further reduced the discrepancy (HR 1.16; 95% CI 0.93–1.44; ΔRMST 2.93 months). Across the full plausible dependence range (θ = 0.08–0.40), findings remained consistent (HR 1.35–1.44). For overall survival, observed/predicted differences were larger (HR 1.87; 95% CI 1.61–2.17; <em>r</em> = 0.97; ΔRMST 7.59 months), but these results were considered exploratory due to substantial confounding from postprogression therapies.</div></div><div><h3>Conclusions</h3><div>These findings did not identify any population-level benefit of triplet therapy that clearly exceeded predictions under an independent-action model, although synergistic effects at the individual-patient level cannot be excluded. These findings support selective or sequential treatment strategies to optimize the benefit-toxicity balance in appropriate patient populations.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110990"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024973","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":"High AST and the presence of liver metastases may guide for the need for FDG PET in advanced prostate cancer patients","authors":"Tugce Telli M.D., F.E.B.N.M. ,&nbsp;Murat Tuncel M.D. ,&nbsp;Erdem Karabulut Ph.D. ,&nbsp;Sercan Aksoy M.D. ,&nbsp;Mustafa Erman M.D. ,&nbsp;Bulent Akdogan M.D. ,&nbsp;Meltem Caglar M.D.","doi":"10.1016/j.urolonc.2025.12.010","DOIUrl":"10.1016/j.urolonc.2025.12.010","url":null,"abstract":"<div><h3>Objective</h3><div>[68Ga]/[18F] labeled Prostate Specific Membrane Antigen (PSMA) is the radiotracer of choice for imaging localized and metastatic prostate cancer with high sensitivity and specificity. On the other hand, 2-[¹⁸F]fluoro-D-glucose (FDG) Positron Emission Tomograpy/Computed Tomography (PET/CT) may help to evaluate the tumor heterogeneity in patients with metastatic castration-resistant prostate cancer (mCRPC) and determine treatment eligibility for Prostate Specific Membrane Antigen (PSMA) targeted radioligand therapy (PSMA-RLT) . The aim of the study is to evaluate the biochemical and clinical parameters which can predict the presence of FDG-PSMA discordant disease.</div></div><div><h3>Material and Methods</h3><div>A total of 70 advanced mCRPC patients who underwent [⁶⁸Ga]Ga-PSMA-11 PET and FDG PET/CT between August 2016 and June 2021 were retrospectively analyzed. Inter-tumoral heterogeneity was both visually and semi-quantitatively evaluated. Baseline clinical, laboratory and PSMA PET/CT related semi-quantitative parameters were analyzed to predict FDG discordant disease with logistic regression analysis.</div></div><div><h3>Results</h3><div>29/70 (41.4%) of the patients had FDG-PSMA discordant disease. Overall 427 mismatch lesions (FDG+PSMA-) were detected: the majority of these lesions were in the bones (<em>n</em> = 236, 55.2%), lymph nodes (<em>n</em> = 95, 22.2%), and visceral organs (<em>n</em> = 88, 20.6%). Most significant parameters to predict FDG-PSMA discordant disease were liver metastases (HR= 26.5, 95%CI 2.3-302.9, <em>P</em> = 0.008) and serum AST (HR= 1.15, 95%CI 1.04-1.26, <em>P</em> = 0.007).</div></div><div><h3>Conclusion</h3><div>The presence of liver metastases and elevated AST may be easily used in clinical practice to predict FDG-PSMA discordant disease.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110974"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145982027","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":"Clinical stage IIA/B embryonal carcinoma predominant nonseminomatous germ cell tumor: Minimizing treatment burden","authors":"Jiping Zeng M.D. ,&nbsp;Parth Thakker M.D. ,&nbsp;Timothy A. Masterson M.D. ,&nbsp;Nabil Adra M.D. ,&nbsp;Lawrence H. Einhorn M.D. ,&nbsp;Clint Cary M.D., M.P.H., M.B.A.","doi":"10.1016/j.urolonc.2026.111004","DOIUrl":"10.1016/j.urolonc.2026.111004","url":null,"abstract":"<div><h3>Purpose</h3><div>Embryonal carcinoma predominance (ECP) in the orchiectomy specimen is linked to a higher risk of retroperitoneal and systemic relapse. Both chemotherapy and primary retroperitoneal lymph node dissection (RPLND) are recommended options. This study aims to investigate which approach minimizes treatment burden.</div></div><div><h3>Methods</h3><div>We queried the Indiana University Testicular Cancer Database to identify patients with nonseminomatous germ cell tumors (NSGCT) and ECP &gt;50% in the orchiectomy specimen, stage II with retroperitoneal adenopathy &lt;3 cm, and normal serum tumor markers. Patients with malignant transformation (n = 3) or bilateral cancer (n = 3) or receiving 1 to 2 cycles of BEP after orchiectomy were excluded (n = 14). Treatment courses and outcomes were compared.</div></div><div><h3>Results</h3><div>Between 2005 and 2022, 126 patients met the criteria. Of 67 patients who underwent primary RPLND, 62 had active EC in final pathology. Adjuvant chemotherapy (2 cycles of EP or BEP) was given to 5 patients. After a median follow-up of 37.7 months, 10 recurred, with a 3-year recurrence-free survival (RFS) of 85.1%. After induction chemotherapy, 9 patients were disease-free, with 1 disease-related death. The overall survival (OS) after RPLND plus/minus chemotherapy was 98.5%.</div><div>Of the 59 patients who received upfront chemotherapy, 13 required postchemotherapy (PC) RPLND, and 1 recurred and needed chest surgery. Among the 46 patients (78%) who had complete remission after chemotherapy, 5 recurred, requiring second-line chemotherapy in 1 and high-dose chemotherapy in 4. The 3-year RFS was 89.8%. The OS after chemotherapy plus/minus salvage therapy was 98.3%.</div></div><div><h3>Conclusion</h3><div>Primary RPLND achieved complete remission as a single treatment modality in 85% of patients, compared to 78% for chemotherapy. Recurrence after primary RPLND could be effectively treated by chemotherapy. Primary RPLND may reduce treatment burden in early-stage II ECP NSGCT.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 111004"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173861","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":"Estimating the prevalence of germline mutations in DNA mismatch repair genes among patients with upper tract urothelial carcinoma: a systematic review and meta-analysis","authors":"Joseph Moryousef MD ,&nbsp;Braden Millan MD ,&nbsp;Piotr Zareba MD","doi":"10.1016/j.urolonc.2026.110999","DOIUrl":"10.1016/j.urolonc.2026.110999","url":null,"abstract":"<div><h3>Background</h3><div>Lynch syndrome is a hereditary cancer predisposition syndrome caused by germline mutations in the DNA mismatch repair (MMR) genes <em>MSH2, MSH6, MLH1</em> and <em>PMS2</em>. The objective of this systematic review was to estimate the prevalence of germline mutations in MMR genes among patients with upper tract urothelial carcinoma (UTUC).</div></div><div><h3>Methods</h3><div>Literature searches were performed using MEDLINE, EMBASE and Web of Science Core Collection. Studies of interest were selected and data were abstracted independently by two reviewers. Prevalence estimates were transformed using the Freeman-Tukey method and pooled using a random effects model. Heterogeneity and publication bias were assessed quantitatively using the <em>I²</em> statistic and Egger’s test, respectively.</div></div><div><h3>Results</h3><div>Fourteen studies, which included 2,378 patients, were found. Eight of these studies were performed either in China or Japan, with the remainder coming from the United States and Europe. The pooled prevalence of germline mutations in MMR genes was 3.2% (95% confidence interval [95% CI] 2.1%, 4.4%, <em>I²</em>=54%). The prevalence was lower among studies from East Asia than those from North America and Europe (2.4% vs. 4.7%, <em>P</em>=0.087). <em>MSH2</em> was the most commonly mutated gene and 86% of the patients who tested positive were less than 60 years of age or had a prior cancer diagnosis.</div></div><div><h3>Conclusions</h3><div>LS prevalence among patients with UTUC is similar to that among patients with colorectal and endometrial cancers, which provides a strong rationale for LS testing in this population. Further research is necessary to determine the optimal diagnostic strategy.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110999"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166494","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":"Venous invasion in upper tract urothelial carcinoma: Diagnostic features and oncologic outcomes","authors":"Stephan Brönimann MD ,&nbsp;Zahra Moghimi MD ,&nbsp;Philipp Korn MD ,&nbsp;Ezra Baraban MD ,&nbsp;Farzad Sedaghat MD ,&nbsp;Nirmish Singla MD, MSCS","doi":"10.1016/j.urolonc.2026.110998","DOIUrl":"10.1016/j.urolonc.2026.110998","url":null,"abstract":"<div><h3>Objectives</h3><div>To characterize clinical, radiological and histopathological features of upper tract urothelial carcinoma (UTUC) with venous tumor thrombus (VTT) and assess associated oncological outcomes in patients who underwent radical nephroureterectomy (RNU).</div></div><div><h3>Material and methods</h3><div>We retrospectively identified consecutive patients with UTUC with VTT who underwent radical nephroureterectomy (RNU) at our institution. Cross-sectional imaging was reviewed by a dedicated genitourinary radiologist, and pathology was reviewed by a dedicated genitourinary pathologist. Clinical characteristics, radiographic features, pathologic features, and oncologic outcomes were analyzed.</div></div><div><h3>Results</h3><div>Eight patients (median age: 74 years, range: 56–91) with UTUC and macroscopic VTT were identified. Imaging consistently revealed collecting system filling defects, irregular mural thickening, and an infiltrative, noncircumscribed growth pattern. Venous involvement was confined to the renal vein in 63% and extended into the inferior vena cava in 37%. Seventy-five percent of patients had pT4 disease, and 63% had pathologic nodal involvement (pN+). Sarcomatoid differentiation was present in 88% of tumors and was disproportionately enriched within the thrombus component, while absent in nodal metastases. One patient experienced a major complication (Clavien–Dindo ≥ III) from surgery. Over a median follow-up of 13.3 months (IQR: 7.7–41.4), 71% of patients developed metastatic disease, and overall mortality was 62.5%. Two patients received adjuvant chemotherapy following surgery. Notably, one achieved a complete response to pembrolizumab, confirmed radiologically and by circulating tumor DNA (ctDNA) clearance.</div></div><div><h3>Conclusions</h3><div>UTUC with VTT represents a rare but distinctly aggressive phenotype characterized by advanced local stage, frequent nodal involvement, and a striking prevalence of sarcomatoid differentiation. The consistent enrichment of sarcomatoid elements within thrombi suggests a unique biologic behavior potentially driven by epithelial-mesenchymal transition that may underlie vascular invasion and influence treatment response. Recognizing key imaging features may facilitate accurate diagnosis, avoid misclassification as RCC, and prompt timely multimodal treatment.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110998"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137834","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":"Does the urinary microbiome reflect the bladder-cancer-associated microbiome? Characterizing the microbiome in urine and cancer tissue in bladder cancer","authors":"Ahmed A. Hussein ,&nbsp;Yakov Klugman ,&nbsp;Jordan Carlson ,&nbsp;Tariq A. Bhat ,&nbsp;Zhe Jing ,&nbsp;Eduardo Cortes Gomez ,&nbsp;Prashant K. Singh ,&nbsp;Jianmin Wang ,&nbsp;Justine Jacobi ,&nbsp;Gary Smith ,&nbsp;David Goodrich ,&nbsp;Khurshid A. Guru","doi":"10.1016/j.urolonc.2025.12.014","DOIUrl":"10.1016/j.urolonc.2025.12.014","url":null,"abstract":"<div><h3>Introduction</h3><div>We sought to characterize the microbiome in bladder cancer tissue samples and to compare it with the microbiome in simultaneously collected urine.</div></div><div><h3>Methods</h3><div>Bladder cancer tissue and transurethral urine specimens were collected simultaneously from consecutive patients with bladder cancer at the time of transurethral resection of bladder tumor (TURBT) or radical cystectomy (RC). Samples were analyzed using 16S rRNA sequencing. Urinary and tissue microbiome were compared. Overlaps among bladder cancer tissue and respective urine samples were described. Microbiome was further described in terms of alpha (diversity within a sample measured by Observed, Chao1, Shannon, and Simpson indices), beta diversities (diversity among different samples measured by Bray Curtis Diversity index) and differential abundance of bacteria at the genus level.</div></div><div><h3>Results</h3><div>Twenty-one patients were included in the study (15 males and 6 females). Transurethral urine samples were available for all but 3 patients, where voided samples were used. Nineteen patients had high grade urothelial carcinoma and 2 had low grade. Looking at the overlapping genera among the urine and tissue samples, only <em>Pseudomonas, Staphylococcus, Acinetobacter, Corynebacterium, Escherichia-Shigella, Anaerococcus, Streptococcus</em>, and <em>Prevotella</em> were present in &gt;75% of both urine and tissue samples. Comparing tissue and urine specimens, there was no significant difference across all alpha diversity indices, while Bray Curtis for beta diversity showed significant dissimilarity (p&lt;0.0001). There was significantly higher abundance of <em>Moraxella, Herbaspirillum, Clostridium sensu stricto 8, Cellulomonas, Pleomorphomonas, Conchiformibius, Prevotella_9, Lachnospiraceae, Marmoricola, Pseudoglutamicbacter, Helicobacter, Jeotgalicoccus, Roseburia, Granulicatella, Lachnoclostridium, Odoribacter, Dermabacter, Akkermansia, Abiotrophia</em>, and <em>Reinbacterium</em> in the urine samples. On the other hand, there was significantly higher abundance of <em>Conexibacter, Cnuella, Mobilitalea, Fulvimonas, Pedomicrobium, Pectobacterium, Weissella, Selenomonas, Tannerella, Aliterella, Xanthobacter, Sporosarcina, Gordonia, Bosea, Pantoea, SM1A02, Vibrio, Pediococcus, Lacticaseibacillus</em> and <em>Blastococcus</em> in the tissue specimens.</div></div><div><h3>Conclusion</h3><div>In this cohort, bladder-cancer tissue associated microbiome exhibited a distinct microbial signature when compared to urine. These results suggest that the urinary microbiome may not provide an accurate representation of the bladder-cancer associated microbiome. Validation in larger, standardized cohorts with contamination control is warranted.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110978"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019814","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}