Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Beyond clear cell: Rare histologic and molecular variants of renal cell carcinoma.","authors":"Ali Moradi, Jadon Fann, George Zhang, Sumanta K Pal, Evita Sadimin","doi":"10.1016/j.urolonc.2026.111066","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.111066","url":null,"abstract":"<p><p>Renal cell carcinoma (RCC) represents a complex and heterogeneous group of renal malignancies, encompassing the predominant clear cell RCC (ccRCC) as well as a broad spectrum of nonclear cell RCC (non-ccRCC) subtypes. Advances in histopathology and genomic profiling have significantly refined RCC classification, enabling integration of morphological, immunohistochemical, and molecular features to enhance diagnostic precision, prognostication, and individualized treatment planning. While the 2022 5th edition of the WHO Classification continues to prioritize histopathologic assessment, it introduces a novel category of molecularly defined renal carcinomas, classifying tumors based on specific genetic and molecular features and reflecting advances in tumor biology. Herein, non-ccRCC includes different subtypes of papillary, chromophobe, tubulocystic, oncocytoma, eosinophilic solid and cystic, and collecting duct carcinomas, as well as several molecularly defined entities. Rare histological subtypes and molecularly characterized tumors, including ALK-rearranged, FH-deficient, SDH-deficient, TFEB/TFE3-rearranged, ELOC-mutated, and SMARCB1-deficient RCCs, demonstrate distinct clinical behavior, variable aggressiveness, and specific therapeutic vulnerabilities, underscoring the importance of accurate molecular diagnosis. Non-ccRCC subtypes remain a clinical challenge due to their relative rarity, histological heterogeneity, and underrepresentation in clinical trials, often necessitating the extrapolation of treatment paradigms from ccRCC. Emerging targeted therapies and immunotherapeutic strategies show promise for these rare RCCs, emphasizing the need for subtype-specific clinical research. This review provides a comprehensive overview of the histological and molecular rare variants of RCC, highlights diagnostic innovations, and discusses the implications of these insights for precision medicine and future therapeutic development in kidney cancer.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":"111066"},"PeriodicalIF":2.3,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575538","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":"Cover 2 - Masthead","authors":"","doi":"10.1016/j.urolonc.2026.111044","DOIUrl":"10.1016/j.urolonc.2026.111044","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 3","pages":"Article 111044"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396858","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":"Microbiome-linked transcriptomic signatures in NMIBC: Toward personalized uro-oncology","authors":"Manoj Das MBBS, MS, MCh ,&nbsp;Shree Rath MBBS ,&nbsp;Rohith Gorepatti MBBS, MS, MCh ,&nbsp;Rishikesh Dash MSc ,&nbsp;Abhishek Akella MBBS ,&nbsp;Abhay Singh Gaur MBBS, MS, MCh ,&nbsp;Giriprasad Venugopal MSc, PhD ,&nbsp;Zaiba Hasan Khan MSc, PhD ,&nbsp;Balamurugan Ramadass MSc (Med), PhD ,&nbsp;Prasant Nayak MBBS, MS, MCh","doi":"10.1016/j.urolonc.2025.12.013","DOIUrl":"10.1016/j.urolonc.2025.12.013","url":null,"abstract":"<div><h3>Background</h3><div>Nonmuscle Invasive Bladder Cancer (NMIBC) is a prevalent malignancy marked by high recurrence and progression rates. Emerging evidence suggests that demographic and environmental factors may alter the bladder’s native oncobiome, influencing tumor behavior. This exploratory pilot study examined whether paired tumor and adjacent normal bladder mucosa exhibit distinct host transcriptomic and microbial signatures that may illuminate early tumor–microbiome interactions in NMIBC.</div></div><div><h3>Methods</h3><div>A meta-transcriptomic analysis was conducted on paired tumor and adjacent normal bladder mucosa from 6 NMIBC patients. Shotgun RNA sequencing was used to profile differential gene expression and microbial composition. Functional annotation and correlation analyses were performed to explore gene–microbe interactions.</div></div><div><h3>Results</h3><div>Fifty-seven differentially expressed genes (DEGs) across 6 patients and 12 paired samples were identified, including 45 downregulated and 12 upregulated genes, primarily involved in extracellular matrix organization and structural integrity. Tumor tissues exhibited significantly reduced microbial species richness compared to the adjacent normal mucosa (<em>P</em> = 0.026). Propionibacterium acnes showed increased abundance in tumor sites (23.88%) versus the adjacent normal mucosa (13%), suggesting a protumorigenic role. Veillonella dispar and Corynebacterium durum were strongly associated with matrix-regulating genes, while Bifidobacterium longum—more abundant in the adjacent normal tissues—correlated with genes linked to extracellular homeostasis, indicating a potential protective role.</div></div><div><h3>Conclusion</h3><div>This pilot study reveals distinct transcriptomic and microbial signatures in NMIBC, highlighting the role of microbial dysbiosis, which denotes an altered microbial community; reduced diversity and shifts in key taxa relative to the adjacent bladder mucosa, in extracellular matrix remodeling and tumor progression. These host–microbe interactions may contribute to disease pathogenesis and recurrence. Further studies are warranted to elucidate the underlying mechanisms and therapeutic implications.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 3","pages":"Article 110977"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979866","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":"Artificial intelligence-driven prostate cancer diagnosis: Enhancing accuracy and personalizing patient care","authors":"Xiaoyi Zhang M.D. ,&nbsp;Na Xiao B.S.N. ,&nbsp;Hao Liang M.D. ,&nbsp;Peixin Li M.D. ,&nbsp;Yaozhong Zhang M.D. ,&nbsp;Shijie Zhang M.D. ,&nbsp;Bin Zhou M.D. ,&nbsp;Shengwen Yao M.D. ,&nbsp;Zizhuo Yang M.D. ,&nbsp;Jun Chen M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.11.013","DOIUrl":"10.1016/j.urolonc.2025.11.013","url":null,"abstract":"<div><div>Prostate cancer remains a major global burden; diagnostic pathways rely on prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and histopathology but face false positives, interobserver variability, and risk of overtreatment. We conducted a narrative review of peer-reviewed human studies (2015–February 2025; PubMed, Web of Science, Google Scholar) on artificial intelligence (AI) across imaging and digital pathology. Evidence shows that assistive AI can match or exceed expert performance while improving workflow. In a large international paired confirmatory study (PI-CAI), an MRI-based AI system achieved an area under the receiver operating characteristic curve (AUROC) of 0.91 versus 0.86 for 62 radiologists, detected 6.8% more Grade Group (GG) ≥2 cancers at matched specificity, and yielded ∼50% fewer false positives and 20% fewer indolent (GG1) detections at matched sensitivity. Risk tools configured for high-sensitivity rule-out (90%–95%) report high negative predictive value (NPV) 97.5% to 98.0% and enable meaningful biopsy avoidance. In digital pathology, independent assessments of Paige Prostate report 97.7% sensitivity and 99.3% specificity on core biopsies, while real-world deployments reduce immunohistochemistry requests, second-opinion rates, and reporting time. Collectively, these data support deploying AI as a second-reader/triage with standardized acquisition and quality assurance, local calibration, and drift monitoring. Priority evidence needs include multicenter prospective studies and pragmatic real-world evidence (RWE) reporting patient outcomes and cost-effectiveness, with continued attention to fairness, privacy, and regulatory compliance.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 3","pages":"Article 110959"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805636","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":"Comparison of prostate-specific antigen kinetics between androgen receptor signaling inhibitor doublet therapy and androgen receptor signaling inhibitor with docetaxel triplet therapy in patients with metastatic castration-sensitive prostate cancer","authors":"Tsuyoshi Morita ,&nbsp;Yutaka Yamamoto ,&nbsp;Saizo Fujimoto ,&nbsp;Mamoru Hashimoto ,&nbsp;Takafumi Minami ,&nbsp;Wataru Fukuokaya ,&nbsp;Fumihiko Urabe ,&nbsp;Takafumi Yanagisawa ,&nbsp;Akihito Takeuchi ,&nbsp;Ryoichi Maenosono ,&nbsp;Takuya Tsujino ,&nbsp;Hirofumi Morinaka ,&nbsp;Kiyoshi Takahara ,&nbsp;Kazumasa Komura ,&nbsp;Teruo Inamoto ,&nbsp;Haruhito Azuma ,&nbsp;Takahiro Kimura ,&nbsp;Kazutoshi Fujita","doi":"10.1016/j.urolonc.2025.12.004","DOIUrl":"10.1016/j.urolonc.2025.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Doublet therapy of androgen deprivation therapy (ADT) with androgen receptor signaling inhibitor (ARSI) or triplet therapy of ADT with docetaxel and ARSI represent possible treatment options in patients with metastatic castration-sensitive prostate cancer (mCSCaP). However, real-world data comparing these 2 treatments are lacking. Our objective was to compare prostate-specific antigen (PSA) kinetics between doublet and triplet therapy in patients with mCSCaP.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed systemic treatment-naïve mCSCaP patients treated in Japan between 2018 and 2024. The patients received either doublet or triplet therapy. PSA nadir (≤ 0.02 ng/ml) and PSA response rates (≥ 90%, ≥ 99% reduction from baseline at 3 months) were assessed. Propensity score matching (2:1 ratio) was used to balance patient characteristics.</div></div><div><h3>Results</h3><div>After matching 768 patients with mCSCaP, 188 patients were included in the doublet and 94 in the triplet therapy groups. At 12 months, the proportion of patients achieving PSA ≤ 0.02 ng/ml was significantly higher in the triplet group than in the doublet group (<em>P</em> &lt; 0.05), particularly among those with high-volume disease. PSA response ≥ 99% at 3 months was comparable between the 2 groups (<em>P</em> = 0.08). Treatment related adverse events (TRAEs) of grade ≥ 3 were more frequent with triplet therapy.</div></div><div><h3>Conclusions</h3><div>Triplet therapy may offer superior PSA decline in patients with high-volume disease, however, this benefit comes at the cost of increased toxicity. Treatment choice should consider disease volume and patient tolerability.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 3","pages":"Article 110968"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850762","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":"Prostate cancer mortality is expected to rise by 2050","authors":"Alon Lazarovich M.D., M.B.A.,&nbsp;Scott Eggener M.D.","doi":"10.1016/j.urolonc.2026.111023","DOIUrl":"10.1016/j.urolonc.2026.111023","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 3","pages":"Article 111023"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158459","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":"Real-world treatment patterns, recurrence, and overall survival of patients with muscle-invasive bladder cancer undergoing radical cystectomy in U.S. oncology practice","authors":"Patrick Squires Pharm.D., Ph.D. ,&nbsp;Francesca Coutinho M.B.B.S., M.P.H. ,&nbsp;Jon G. Tepsick M.S. ,&nbsp;Aljosja Rogiers M.D., Ph.D. ,&nbsp;Chethan Ramamurthy M.D. ,&nbsp;Haojie Li M.D., Ph.D. ,&nbsp;Todd M. Morgan M.D.","doi":"10.1016/j.urolonc.2025.12.018","DOIUrl":"10.1016/j.urolonc.2025.12.018","url":null,"abstract":"<div><h3>Background</h3><div>The most common treatment for muscle-invasive bladder cancer (MIBC) is radical cystectomy (RC), typically combined with neoadjuvant and/or adjuvant therapy. This study aimed to describe patient characteristics, treatment patterns, recurrence, and overall survival (OS) among a contemporary cohort of patients with MIBC who underwent RC.</div></div><div><h3>Methods</h3><div>This retrospective study included adult patients with MIBC (T2-T4aN0M0/T1-T4aN1M0) who underwent RC between January 1, 2008 and July 31, 2023 and were captured in the U.S. ConcertAI Patient360™ Bladder Cancer electronic medical record database. Index date was defined as the date of RC. Recurrence (first evidence of disease following RC) and OS were analyzed using Kaplan-Meier methods and stratified by disease stage and treatment received. The association of recurrence with OS was assessed using Cox regression.</div></div><div><h3>Results</h3><div>A total of 783 RC-treated MIBC patients were included (median age 68 years; male 78.8%; White 87.6%; de novo MIBC 77.1%; pure urothelial histology 76.6%), with a median follow-up of 26.2 months. Neoadjuvant therapy use increased from 30.3% in 2011–2013 to 67.9% in 2020–2022. Among patients who received neoadjuvant therapy, 26.3% achieved pathological complete response (pT0N0) at RC. The 5-year recurrence and OS rates were 45.2% and 48.2%, respectively, varying by stage and treatments received. Mortality was 4.4 times higher [95% CI: 3.5, 5.6] among patients with recurrence compared with those without.</div></div><div><h3>Conclusion</h3><div>Despite increased utilization of perioperative therapy over the past 2 decades, MIBC patients undergoing RC continue to experience high rates of disease recurrence, which are associated with increased mortality.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 3","pages":"Article 110982"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979865","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 perilesional sampling in the era of targeted prostate biopsy: A scoping review","authors":"Charalampos Mavridis M.D., Ph.D. ,&nbsp;Maria Chrisoula Nakou M.D. ,&nbsp;Charalampos Mamoulakis M.D., Ph.D. ,&nbsp;Theodoros Tokas M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.12.009","DOIUrl":"10.1016/j.urolonc.2025.12.009","url":null,"abstract":"<div><div>Multiparametric MRI (mpMRI) has reshaped prostate cancer diagnosis. However, Multiparametric MRI (mpMRI) often underestimates the tumor extent. Perilesional biopsy (PB) helps avoid excessive numbers of systematic biopsy (SB) cores. Nevertheless, there are concerns about the potential misses of contralateral clinically significant prostate cancer (csPCa). Despite ongoing research, a lack of high-quality studies remains. This scoping review examined the impact of PB in detecting csPCa, as well as the potential advantages and drawbacks of perilesional sampling compared to TB and systematic biopsy (SB) approaches. We conducted a PRISMA-based systematic search in Pubmed, Scopus, and WOS. We identified 77 articles, and nineteen PB studies were selected. Fourteen studies utilized an MRI-TRUS fusion software. Ten applied a sector-based or quadrant-based definition of perilesional sampling, and 8 adopted a precise mm-based definition, within a 5 mm or a ≤ 10 mm perilesional margin. We discovered a significant methodological diversity, particularly in terms of direct comparisons. Included studies recorded a wide range of csPCa detection rates (35%–99%). There were contradictory findings regarding the impact of PB on the detection rates of csPCa. Adding PB to TB decreased the detection of insignificant prostate cancer, the number of biopsy cores, and the upgrading rates in radical prostatectomy specimens. Six and 13 studies were rated as high- and moderate-risk of overall bias according to the ROBINS-I framework. Perilesional sampling during prostate biopsy is a promising yet immature strategy for detecting csPCa. The heterogeneity of methods and the lack of a standardized protocol hinder widespread adoption.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 3","pages":"Article 110973"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952747","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":"Disitamab vedotin with or without PD-1 inhibitors in pretreated patients with locally advanced or metastatic urothelial carcinoma: Identifying patients who derive additional benefit from immune combination therapy","authors":"Mengnan Qu ,&nbsp;Jinchang Wei ,&nbsp;Jiazhi Mo ,&nbsp;Jiayuan Chen ,&nbsp;Xiaowen Wu ,&nbsp;Huayan Xu ,&nbsp;Li Zhou ,&nbsp;Juan Li ,&nbsp;Xieqiao Yan ,&nbsp;Chuanliang Cui ,&nbsp;Lu Si ,&nbsp;Zhihong Chi ,&nbsp;Jun Guo ,&nbsp;Xinan Sheng","doi":"10.1016/j.urolonc.2025.12.006","DOIUrl":"10.1016/j.urolonc.2025.12.006","url":null,"abstract":"<div><h3>Background</h3><div>The relative clinical value of disitamab vedotin (RC48) monotherapy versus its combination with a programmed cell death protein 1 (PD-1) inhibitor remains unclear in previously treated patients with locally advanced or metastatic urothelial carcinoma (LA/mUC). Identifying patients who truly benefit from immunotherapy intensification is therefore critical to guide personalized treatment and avoid overtreatment.</div></div><div><h3>Patients and Methods</h3><div>We conducted a retrospective analysis to compare the clinical outcomes of RC48 monotherapy versus its combination with a PD-1 inhibitor in pretreated patients with LA/mUC. To address potential confounders, multiple imputation and inverse probability of treatment weighting (IPTW) were employed. The primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and safety assessment.</div></div><div><h3>Results</h3><div>The median follow-up for the 195 patients was 10.3 months. No significant difference in OS was observed between combination therapy and monotherapy (median OS, 16.7 vs. 22.0 months; HR 1.09; 95% confidence intervals [95% CI], 0.67–1.78; <em>P</em> = 0.73). PFS, ORR, and DCR did not differ significantly between groups. In exploratory analyses, patients with HER2-positive and PD-L1–negative tumors showed improved outcomes with combination therapy (OS HR 0.28; 95% CI, 0.09–0.86; <em>P</em> = 0.03; PFS HR 0.46; 95% CI, 0.24–0.89; <em>P</em> = 0.02). PFS benefit was also observed in those with nondivergently differentiated histology (HR 0.66; 95% CI, 0.44–0.98; <em>P</em> = 0.04).</div></div><div><h3>Conclusion</h3><div>While RC48 combined with a PD-1 inhibitor did not confer survival advantage in the overall population, patients with HER2-positive and PD-L1-negative tumors, as well as those without divergent histologic differentiation, may derive additional benefit from combination therapy. Safety findings were consistent with prior experience.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 3","pages":"Article 110970"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850798","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":"Prostate cancer-related genetic counseling in a safety-net healthcare setting","authors":"Prisca Mbonu ,&nbsp;Jacqueline Mersch M.S., C.G.C. ,&nbsp;Jana Heady M.S., C.G.C. ,&nbsp;Samuel Newman M.S. ,&nbsp;Jolonda C. Bullock O.D.S-C. ,&nbsp;Kyle Seymour ,&nbsp;David E. Gerber M.D. ,&nbsp;Kalyani Narra M.D.","doi":"10.1016/j.urolonc.2025.12.003","DOIUrl":"10.1016/j.urolonc.2025.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Germline genetic testing and genetic counseling have become integral aspects of prostate cancer management. In 2018, the National Comprehensive Cancer Network (NCCN) broadened testing recommendations to identify more at-risk individuals based on tumor characteristics and family cancer history. We assessed genetic counseling referrals and outcomes in relation to this expansion in a large safety-net population.</div></div><div><h3>Methods</h3><div>We analyzed cases of prostate adenocarcinoma diagnosed in 2016 to 2023 at JPS Health Network (JPS), a safety-net provider in Texas. Demographic and clinical data including genetic counseling referrals and testing results were obtained from cancer registries and electronic health records. Statistical analysis was performed using logistic regression model.</div></div><div><h3>Results</h3><div>Among 543 patients, 46% were Black, 27% were Hispanic, and 40% had metastatic disease. Overall, 132 patients (24%) were referred for genetic counseling, of whom 102 (77%) completed the visits. Rates of referrals increased from 4% in 2017 to 9% in 2019 to 28% in 2023. A multivariate logistic regression determined that patients with stage 3 or 4 cancers were more likely than stage 1 to be referred (<em>P</em> = 0.02 and <em>P</em> &lt; 0.01 respectively). Genetic testing was completed for 78 patients (76%) with 8 (10%) having 9 positive results in <em>BRCA1</em> (<em>n</em> = 1), <em>BRCA2</em> (<em>n</em> = 1), <em>CHEK2</em> (<em>n</em> = 3), <em>MSH2</em> (<em>n</em> = 2), <em>PALB2</em> (<em>n</em> = 1), and <em>PMS2</em> (<em>n</em> = 1).</div></div><div><h3>Conclusion</h3><div>Following guideline changes, genetic testing referrals for patients with prostate cancer increased approximately 7-fold in a safety-net setting. Over three-fourths of referred patients completed testing and 10% had positive results, demonstrating the feasibility and importance of genetic testing in underserved populations.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 3","pages":"Article 110967"},"PeriodicalIF":2.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865739","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}