Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Critical care therapy and in-hospital mortality after radical nephroureterectomy for nonmetastatic upper urinary tract carcinoma","authors":"Francesco Di Bello M.D. ,&nbsp;Carolin Siech M.D. ,&nbsp;Mario de Angelis M.D. ,&nbsp;Natali Rodriguez Peñaranda M.D. ,&nbsp;Zhe Tian M.Sc. ,&nbsp;Jordan A. Goyal ,&nbsp;Claudia Collà Ruvolo M.D. ,&nbsp;Gianluigi Califano M.D. ,&nbsp;Massimiliano Creta M.D. ,&nbsp;Fred Saad M.D., Ph.D. ,&nbsp;Shahrokh F. Shariat M.D. ,&nbsp;Alberto Briganti M.D., Ph.D. ,&nbsp;Felix K.H. Chun M.D. ,&nbsp;Stefano Puliatti M.D. ,&nbsp;Nicola Longo M.D. ,&nbsp;Pierre I. Karakiewicz M.D.","doi":"10.1016/j.urolonc.2024.09.035","DOIUrl":"10.1016/j.urolonc.2024.09.035","url":null,"abstract":"<div><h3>Background</h3><div>Use of critical care therapies (CCT), that include invasive mechanical ventilation (IMV), total parenteral nutrition (TPN) and other modalities are unknown after radical nephroureterectomy (RNU) for upper urinary tract carcinoma (UUTC). Their relationship with in-hospital mortality is also unknown.</div></div><div><h3>Methods</h3><div>Within the National Inpatient Sample (2008–2019), we identified non-metastatic UUTC patients treated with RNU. Multivariable logistic regression models were used.</div></div><div><h3>Results</h3><div>Of 8,995 patients, 375 (4.2%) received CCT and 82 (0.9%) experienced in-hospital mortality. Of CCT modalities, 215 (2.4%) received IMV and 139 (1.5%) TPN. Temporal CCT, IMV, and TPN trends very closely followed in-hospital mortality trends. Relative to historical UUTC patients (2008–2013), contemporary (2014–2019) patients exhibited lower CCT (Δ = 2.2%, <em>P</em> value &lt; 0.0001), lower IMV (Δ = 1.4%, <em>P</em> &lt; 0.0001), lower TPN (Δ = 2.2%, <em>P</em> &lt; 0.0001), and lower in-hospital mortality (Δ = 0.4%, <em>P</em> = 0.03) rates. Of in-hospital mortalities, 52 out of 82 received CCT but 30 of 82 did not. Median age (&gt; 72 years; odds ratio [OR] 1.4; <em>P</em> = 0.002) and Charlson comorbidity index ≥ 3 (OR 4.1; <em>P</em> &lt; 0.001) and ≥ 1-2 (OR 1.7; <em>P</em> = 0.001) independently predicted overall higher CCT, IMV, TPN, and in-hospital mortality.</div></div><div><h3>Conclusion</h3><div>After RNU, CCT rates parallels in-hospital mortality rates. CCT represents a 5 to 6-fold multiple of in-hospital mortality rate. In RNU patients, CCT rates are higher in older and sicker individuals. Lower CCT rates that are paralleled by lower in-hospital mortality may be interpreted as an indicator of improved quality of care. Ideally all in-hospital mortalities should be predated by CCT exposure.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 328.e9-328.e15"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475859","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":"Pathologic prostate cancer grade concordance among high-resolution micro-ultrasound, systematic transrectal ultrasound and MRI fusion biopsy","authors":"Soum D. Lokeshwar M.D., M.B.A.,&nbsp;Ankur U. Choksi M.D.,&nbsp;Shayan Smani B.S.,&nbsp;Victoria Kong B.S.,&nbsp;Vinaik Sundaresan B.S.,&nbsp;Ryan Sutherland M.P.H, M.Phi.,&nbsp;Joseph Brito M.D.,&nbsp;Joseph F Renzulli M.D.,&nbsp;Preston C. Sprenkle M.D.,&nbsp;Michael S. Leapman M.D., M.H.S.","doi":"10.1016/j.urolonc.2024.10.018","DOIUrl":"10.1016/j.urolonc.2024.10.018","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and Objective&lt;/h3&gt;&lt;div&gt;Comparative studies among biopsy strategies have not been conducted evaluating pathologic concordance at radical prostatectomy(RP), especially with novel micro-ultrasound (micro-US) image-guided biopsy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective study among patients with PCa who underwent RP following TRUS, MRI-TRUS fusion, microUS, or MRI-microUS fusion biopsy in a multi-site single institution. We compared GG-upgrade from biopsy to RP based on highest GG in any biopsy core and examined clinical/pathologic factors associated with pathologic upgrading using descriptive statistics, and multivariable logistic-regression analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;429 patients between 1/2021 and 6/2023 including 10 (25.6%) who underwent systematic TRUS, 237 (55.2%) MRI-TRUS, 67 (15.6%) MRI-microUS and 15 (3.5%) micoUS-alone biopsy prior to RP. 78 (18.2%) were upgraded on final pathology (TRUS 31 (28.2%), MRI-TRUS 31 (13.1%), MRI-microUS 10 (14.9%), microUS: 6 (40%)) and 99 downgraded. 14 (3.5%) experienced a major upgrade (≥2 GG increase). On multivariable-analysis both MRI-TRUS (odds ratio, OR: 0.31,95% CI:0.17–0.56, &lt;em&gt;P&lt;/em&gt; &lt; 0.001) and MRI-microUS (OR: 0.43,95%CI: 0.19–0.98, &lt;em&gt;P&lt;/em&gt; = 0.044) were associated with lower odds pathological-upgrade compared with TRUS biopsy alone. No significant differences in the odds of upgrade between TRUS and microUS alone (&lt;em&gt;P&lt;/em&gt; &gt; 0.05), or between MRI-microUS and MRI-TRUS(&lt;em&gt;P&lt;/em&gt; = 0.696) on pairwise comparisons. MRI-microUS was associated with lower upgrade compared with microUS (OR: 0.26,95% CI:0.08–0.90, &lt;em&gt;P&lt;/em&gt; = 0.034). No difference among the biopsy strategies in pathologic downgrading or overall GG concordance. Limitations include retrospective analysis, inter-clinician experience and lesion selection in varying biopsy techniques.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Both MRI-microUS and MRI-TRUS fusion were associated with similarly improved GG concordance compared with TRUS biopsy. No significant differences between microUS-alone and TRUS or between MRI-microUS and MRI-TRUS fusion approaches, may suggest similar accuracy performance for disease sampling.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;What does the study add&lt;/h3&gt;&lt;div&gt;To our knowledge, this is the first study to investigate GG concordance based on type of biopsy, especially microUS related GG upgrading after RP. In a moderately sized cohort this is the first to investigate pathologic concordance in MRI-microUS fusion compared to MRI-TRUS fusion biopsy. Our study may help urologists in counseling patients after biopsy and choosing the ideal image guided biopsy technique, however randomized controlled trials are needed to validate our results.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient Summary&lt;/h3&gt;&lt;div&gt;We performed a study to see if the type of prostate biopsy, including use of MRI assistance as well as a new image-guided biopsy using a more advanced ultrasound, was better able to identify the aggress","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 336.e13-336.e20"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629080","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":"Development of TAR-200: A novel targeted releasing system designed to provide sustained delivery of gemcitabine for patients with bladder cancer","authors":"Siamak Daneshmand M.D. ,&nbsp;Ashish M. Kamat M.D., M.B., B.S. ,&nbsp;Neal D. Shore M.D. ,&nbsp;Joshua J. Meeks M.D., Ph.D. ,&nbsp;Matthew D. Galsky M.D. ,&nbsp;Joseph M. Jacob M.D. ,&nbsp;Michiel S. van der Heijden M.D., Ph.D. ,&nbsp;Stephen B. Williams M.D., M.B.A., M.S. ,&nbsp;Thomas Powles M.D. ,&nbsp;Sam S. Chang M.D. ,&nbsp;James W.F. Catto Ph.D., F.R.C.S. (Urol.) ,&nbsp;Sarah P. Psutka M.D. ,&nbsp;Félix Guerrero-Ramos M.D., Ph.D. ,&nbsp;Evanguelos Xylinas M.D. ,&nbsp;Makito Miyake M.D., Ph.D. ,&nbsp;Giuseppe Simone M.D., Ph.D. ,&nbsp;Karen Daniel Ph.D. ,&nbsp;Hussein Sweiti M.D. ,&nbsp;Christopher Cutie M.D. ,&nbsp;Andrea Necchi M.D.","doi":"10.1016/j.urolonc.2024.12.264","DOIUrl":"10.1016/j.urolonc.2024.12.264","url":null,"abstract":"<div><div>Treatment options for recurrent high-risk non–muscle-invasive bladder cancer (HR NMIBC) and muscle-invasive bladder cancer (MIBC) are limited, highlighting a need for clinically effective, accessible, and better-tolerated alternatives. In this review we examine the clinical development program of TAR-200, a novel targeted releasing system designed to provide sustained intravesical delivery of gemcitabine to address the needs of patients with NMIBC and of those with MIBC. We describe the concept and design of TAR-200 and the clinical development of this gemcitabine intravesical system in the SunRISe portfolio of studies. This includes 3 phase I studies evaluating the safety and initial tumor activity of TAR-200 and 5 phase II/III studies assessing the efficacy and safety of TAR-200, with or without systemic cetrelimab, as a treatment option for patients with HR NMIBC (bacillus Calmette-Guérin naive [papillary and carcinoma in situ] and MIBC (neoadjuvant and patients ineligible for or refusing radical cystectomy). Pharmacokinetics demonstrate intravesical gemcitabine delivery via TAR-200 over a prolonged period without detectable plasma levels. Phase I studies showed that TAR-200 is well tolerated, with preliminary antitumor activity in intermediate-risk NMIBC and MIBC. Preliminary data from the phase IIb SunRISe-1 study demonstrate that TAR-200 monotherapy is safe and effective in patients with bacillus Calmette-Guérin–unresponsive high-risk NMIBC. TAR-200 represents an innovative approach to the local treatment of bladder cancer.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 286-296"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012485","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 obesity on prostatectomy outcomes: Insights from a large prospectively maintained cohort","authors":"Ekamjit S. Deol ,&nbsp;Kelly S. Lehner ,&nbsp;Anthony E. Fadel ,&nbsp;Laureano J. Rangel ,&nbsp;Abhinav Khanna ,&nbsp;Matthew K. Tollefson ,&nbsp;Paras H. Shah ,&nbsp;Igor Frank ,&nbsp;Stephen A. Boorjian ,&nbsp;R. Jeffrey Karnes ,&nbsp;Vidit Sharma","doi":"10.1016/j.urolonc.2025.01.014","DOIUrl":"10.1016/j.urolonc.2025.01.014","url":null,"abstract":"<div><h3>Background</h3><div>In this study we aimed to explore the impact of BMI on perioperative complications, functional outcomes, and oncologic outcomes and longitudinal outcomes.</div></div><div><h3>Methods</h3><div>We queried our prospectively maintained radical prostatectomy (RP) registry from 1986 to 2018 for patients with cM0 prostate adenocarcinoma without prior BPH surgery or radiation therapy. Preoperative BMI was associated with the following outcomes of interest: 30-day complications, 1-year functional outcomes, and oncologic outcomes. Logistic regression analyses were used for complications and surgical outcomes and competing risk Cox proportional hazard models were used for oncologic outcomes.</div></div><div><h3>Results</h3><div>In a cohort of 21,604 patients, 28.9% and 1.0% had BMI &gt; 30 (N = 6,252) and BMI &gt; 40 (N = 222), respectively. Obese patients were more likely to have positive surgical margins (29.4% vs. 25.0%, <em>P</em> &lt; 0.001) and early complications (15.0% vs. 11.1%, <em>P</em> &lt; 0.001) and these were confirmed on multivariable analysis: OR 1.04 (<em>P</em> &lt; 0.001) and OR 1.04 (<em>P</em> &lt; 0.001), respectively. RP on obese patients also had increased operative times and blood loss. Increasing BMI was associated with lower odds for recovering potency (OR 0.95, <em>P</em> &lt; 0.001) but was not associated with lower rates of postoperative continence (OR 1.005, <em>P</em> = 0.403). On multivariable competing risk analysis, patients with BMI &gt; 30 had higher odds of nonprostate cancer mortality but no difference in biochemical failure, metastasis or cancer-specific survival.</div></div><div><h3>Conclusions</h3><div>RP in obese patients can be technically challenging but delivers similar oncologic outcomes to nonobese patients. This information can be useful for patient counseling to support the use of radical prostatectomy in appropriately selected obese patients.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 5","pages":"Pages 334.e7-334.e15"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789195","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":"Assessment of postoperative practices and discharge recommendations after radical prostatectomy.","authors":"Bárbara Vieira Lima Aguiar Melão, Melissa Assel, Maria Pere, Sunny Nalavenkata, Karim A Touijer, Vincent P Laudone, Daniel W Lin, Juan Gomez Rivas, Anders Bjartell, Sigrid V Carlsson","doi":"10.1016/j.urolonc.2025.03.027","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.03.027","url":null,"abstract":"<p><strong>Purpose: </strong>Consistent, accurate postoperative guidance is crucial for early recovery and patient satisfaction in urology, especially for radical prostatectomy (RP) patients. However, patients often receive inconsistent information, highlighting the need for standardized, evidence-based postoperative care guidelines.</p><p><strong>Materials and methods: </strong>We conducted a comprehensive review and evaluation of current postoperative practices for RP. This involved (1) reviewing existing discharge information at Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center to identify areas of improvement; (2) systematically evaluating inconsistencies in discharge instructions and their impact on patient care; (3) distributing an anonymous survey to urologists in the US and Europe via REDCap to gather insights into global postoperative care practices. The survey included questions on various aspects of postoperative care, such as catheter use, medication regimens, dietary restrictions, and physical activity guidelines.</p><p><strong>Results: </strong>We received 247 survey responses. Despite some consensus on certain postoperative practices and recommendations, significant variability existed, underscoring the lack of standardized guidelines. Notable differences were observed between US and European cohorts, particularly in postoperative length of stay and discharge practices. Only 1.4% of US responders discharged patients 3 or more days postsurgery compared to 46% in Europe. Variability was also noted in recommendations for erectile function medications and postoperative activity restrictions.</p><p><strong>Conclusion: </strong>This study underscores the significant variability in postoperative care recommendations for RP and the urgent need for standardized, evidence-based guidelines. Implementing such guidelines will enhance patient recovery, satisfaction, and overall outcomes, improving postoperative care across various surgical procedures.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039623","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":"Strengthening causal inference between gut microbiota and prostate cancer: Methodological considerations and recommendations","authors":"Junxian Zhao M.D. ,&nbsp;Junhao Chen M.Sc., M.D. ,&nbsp;Zegang Liu M.D. ,&nbsp;Wentao Zhang M.D. ,&nbsp;Jianzhong Yao M.D.","doi":"10.1016/j.urolonc.2025.02.019","DOIUrl":"10.1016/j.urolonc.2025.02.019","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Pages 438-439"},"PeriodicalIF":2.4,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154708","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":"Thermal ablation for local tumor recurrence after previous partial nephrectomy: Perioperative and oncological outcomes","authors":"Chiara Vaccaro MD ,&nbsp;Francesco A. Mistretta MD ,&nbsp;Mattia Luca Piccinelli MD ,&nbsp;Elena Lievore MD ,&nbsp;Letizia Maria Ippolita Jannello MD ,&nbsp;Matteo Fontana MD ,&nbsp;Marco Tozzi MD ,&nbsp;Paolo della Vigna MD ,&nbsp;Guido Bonomo MD ,&nbsp;Gianluca Varano MD ,&nbsp;Federico Mastroleo MD ,&nbsp;Giulia Marvaso MD ,&nbsp;Barbara Alicja Jereczek-Fossa MD ,&nbsp;Stefano Luzzago MD ,&nbsp;Franco Orsi MD ,&nbsp;Gennaro Musi MD","doi":"10.1016/j.urolonc.2025.03.018","DOIUrl":"10.1016/j.urolonc.2025.03.018","url":null,"abstract":"<div><h3>Objectives</h3><div>Percutaneous thermal ablation (PTA) has emerged as an alternative to salvage radical nephrectomy (RN) for the treatment of renal cell carcinoma (RCC) local recurrence. We report perioperative and oncological outcomes of patients treated with PTA for RCC local recurrence.</div></div><div><h3>Materials and methods</h3><div>Twenty-seven patients with on-site recurrence received PTA from 2008 to 2022. Primary endpoints were perioperative outcomes, complications, and readmission rates. Secondary endpoints were on site and out site tumor recurrence. Last, we collected renal function outcomes after PTA.</div></div><div><h3>Results</h3><div>Median (IQR) treatment time was 75 (63–106) minutes. Intraoperative complications occurred in 1 (3.7%) patient, while postoperative in 2 (7.4%). Three patients (11%) received incomplete ablation, which required in one an adjunctive PTA and in 2 RN. Overall, 4 (16%) patients developed on site recurrence after a median follow-up of 30 (23–43) months: complete local control was achieved with subsequent PTA in 3 patients, while one developed bone metastases and, therefore, no other local treatments were performed. Moreover, 6 (24%) patients developed out-site recurrence after a median follow-up of 16 (10–23) months. Last, median creatinine drop at 1 month and at 1 year after PTA was -0.03 (-0.11 to 0.01) and -0.11 (-0.20 to -0.05), while median eGFR drop was 2 (0–7.65) and 9.5 (5–13.45).</div></div><div><h3>Conclusion</h3><div>PTA is a safe and feasible approach for management of on-site recurrences after PN. Low perioperative complication rates and optimal local cancer control were achieved in most patients, with no significant impairment of residual renal function.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Pages 444.e1-444.e10"},"PeriodicalIF":2.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025344","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":"Enhancing outcomes in metastatic renal cell carcinoma: Integrating precision radiotherapy with targeted therapy and anti-PD-1 immunotherapy","authors":"Ming-Wei Ma ,&nbsp;Kai-Wei Yang ,&nbsp;Xian-Shu Gao ,&nbsp;Zhi-Song He ,&nbsp;Ke Hu ,&nbsp;Qi Tang ,&nbsp;Jia-Yan Chen ,&nbsp;Qi Shen ,&nbsp;Feng Lyu ,&nbsp;Yi-Xiao Liu ,&nbsp;Wei Yu","doi":"10.1016/j.urolonc.2025.03.016","DOIUrl":"10.1016/j.urolonc.2025.03.016","url":null,"abstract":"<div><h3>Purpose</h3><div>This study assesses the safety and disease control outcomes in metastatic renal cell carcinoma (mRCC) patients undergoing concurrent tyrosine kinase inhibitors (TKI), immune checkpoint inhibitors (ICIs), and high-dose stereotactic ablative body radiotherapy (SABR) .</div></div><div><h3>Patients and Methods</h3><div>Between February 2020 to May 2023, 54 mRCC patients receiving vascular endothelial growth factor (VEGF) targeted therapy and ICIs with high-dose radiotherapy (RT) were included. Genetic testing was performed on 25 pathology samples using the Acornmed 70™ panel. Endpoints included progression-free survival (PFS) 1, PFS2 (time to progression to change systemic therapy), LRFS, OS, disease control rate (DCR) and safety. Kaplan‒Meier analysis was used for time-to-event endpoints. HRs and 95% CIs were calculated. R version 4.3.1 was used for statistical analysis</div></div><div><h3>Results</h3><div>In this study involving 54 patients, SABR was employed in 81% of cases, achieving a 98% DCR. Median PFS1 was 16.9 months, with 2-year PFS2 and OS rates of 53% and 81%, respectively. Subgroup analysis revealed that early RT significantly improved PFS1 (<em>P</em> = 0.023). VHL-driven mRCC demonstrated a trend toward improved PFS1, statistical significance was not reached due to the limited sample size (<em>P</em> = 0.3). Safety analysis indicated grade 3 or 4 treatment-related adverse events in 50% of patients, with no grade 5 events.</div></div><div><h3>Conclusions</h3><div>The investigated trimodality treatment strategy is both safe and effective, resulting in prolonged PFS without requiring a change in systemic treatment. Overall, early RT intervention may offer additional benefits. Future research should provide molecular-level insights into treatment response.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Pages 443.e11-443.e19"},"PeriodicalIF":2.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055519","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":"National complication and cost burden of transurethral resection of bladder tumor for bladder cancer.","authors":"Jj H Zhang, Daniel D Joyce, Yong Shan, Anthony Fadel, Brian Liao, Stephen A Boorjian, Karim Chamie, Stephen B Williams, Vidit Sharma","doi":"10.1016/j.urolonc.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.03.004","url":null,"abstract":"<p><strong>Background: </strong>Transurethral resection of bladder tumor (TURBT) is the gold standard for the diagnosis and treatment of bladder tumors. Although it is a widely-performed urologic surgery, the complication rate and cost burden of TURBT is poorly understood. This study aims to assess factors contributing to increased complications and healthcare cost burden of TURBT.</p><p><strong>Methods: </strong>In this population-based cohort study using Survival Epidemiology, and End Results-Medicare (SEER-Medicare) registry, patients with bladder urothelial carcinoma (UC) who underwent a TURBT between 2004 and 2015 were queried to assess post-TURBT complications and costs. Multivariable logistic regression modeling identified factors associated with 30-day complications. Multivariable linear regression models compared overall costs between patients with and without a complication.</p><p><strong>Results: </strong>In a cohort of 72,284 patients who underwent TURBT for UC, 31,459 (43.5%) of patients experienced at least one complication within 30 days. Factors associated with increased complications include male sex, larger higher grade/stage tumors, repeat TURBTs, concomitant stent placement, and post-TURBT chemotherapy. Having a complication after TURBT was significantly associated with increased overall Medicare cost after multivariable regression adjustment at 30 days ($7393 vs. $3934, P < 0.001), and at multiple time points up to 1 year. Total 30-day Medicare costs measured $207,094,382 (median cost of $2,865 per patient), of which 53% occurred in patients with complications.</p><p><strong>Conclusions: </strong>Complications after TURBT account for a significant proportion of the cost burden of bladder cancer care. A 30-day complication was associated with a 47% increase in per patient Medicare costs. Future studies are needed to reduce complications after TURBT.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034857","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":"Enhanced diagnostic accuracy of micro-ultrasound in prostate cancer detection: An updated series from a single-center prospective study.","authors":"Pier Paolo Avolio, Andrea Piccolini, Cesare Saitta, Vittorio Fasulo, Davide Maffei, Stefano Moretto, Ludovica Cella, Edoardo Beatrici, Giuseppe Chiarelli, Marco Paciotti, Alberto Saita, Rodolfo Hurle, Paolo Casale, Nicolò Maria Buffi, Massimo Lazzeri, Giovanni Lughezzani","doi":"10.1016/j.urolonc.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.03.012","url":null,"abstract":"<p><strong>Introduction: </strong>Multiparametric (mp) magnetic resonance imaging (MRI) is essential for prostate cancer (PCa) detection but is limited by availability, cost, and complexity. Micro-ultrasound (microUS) offers real-time, high-resolution imaging and may enhance clinically significant (cs) prostate cancer (PCa) detection when used with mpMRI. This study updates the diagnostic performance of microUS compared to mpMRI in a large prospective cohort.</p><p><strong>Materials and methods: </strong>We prospectively enrolled 1, 423 men with suspected PCa between October 2017 and April 2024. All patients underwent imaging with the ExactVu system, followed by both microUS-targeted and MRI-targeted biopsies. The primary outcome was the accuracy of detecting csPCa, defined as Gleason score ≥3 + 4 (International Society of Urological Pathology Grade Group ≥2), comparing microUS, mpMRI, and their combined use.</p><p><strong>Results: </strong>CsPCa was diagnosed in 116 (36.3%) patients. MicroUS detected lesions in 1, 076 out of 1, 423 patients (76%) of patients, with a sensitivity of 85% and a negative predictive value of 79% for csPCa. Concordance between microUS and mpMRI findings was 96%. In total, 252 patients (18%) were diagnosed with PCa solely on targeted cores. Among these, 25 csPCa cases were identified exclusively by microUS-targeted and 4 by MRI-targeted biopsies. However, systematic biopsies still identified 22% of csPCa cases missed by both targeted approaches.</p><p><strong>Conclusion: </strong>MicroUS, especially when combined with mpMRI, significantly enhances csPCa detection. This combined imaging approach may reduce the need for systematic biopsies. Further advancements in microUS technology could refine its diagnostic utility.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016511","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}