Current Urology最新文献

{"title":"The efficacy and safety of ureteroscopic lithotripsy and flexible ureteroscopy with continuous anticoagulant or antiplatelet drugs: a multicenter retrospective real-world study","authors":"Zi-Jie Xu, Chu-Jiang He, Jian-Wei Cao, Jian-Hong Wu, Da-Wei Wang, Jun Da, Dong-Liang Xu, Ming-Yue Tan, Xiao-Feng Gao, Yong-Han Peng, Jie Chen, Rong Chen, Peng-Fei Wu, Jun-Tao Jiang, Lei Chen, Shu-jie Xia, Yi Shao","doi":"10.1097/cu9.0000000000000250","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000250","url":null,"abstract":"\u0000 \u0000 \u0000 The objective of this study is to assess the effectiveness and safety of ureteroscopic lithotripsy (URL) and flexible ureteroscopy (fURS) for treating patients on anticoagulant (AC) or antiplatelet (AP) medications.\u0000 \u0000 \u0000 \u0000 The study included 213 patients with urinary stones who underwent URL or fURS between January 2019 and October 2022 at the Shanghai Municipal Hospital Urology Specialist Alliance. Among these patients, 20 received AC therapy, 198 received AP therapy, and 5 received both AC and AP therapy. Patients were divided into 3 groups based on the real-world management of antithrombotic drugs: the continuation group (n = 62), the discontinuation group (n = 91), and the discontinuation and bridge heparin group (n = 60). Intraoperative and postoperative outcomes were compared between the 3 groups.\u0000 \u0000 \u0000 \u0000 Age, sex, body mass index, stone location, stone size, stone side, and residual fragments were not different among the groups. None of the patients received blood transfusions or had thromboembolic events, emergencies for gross hematuria, significant bleeding-related complications, or unplanned secondary ureteroscopic surgery. The mean duration of hospital stay of the continuation group (3.97 days) was significantly lower than that of the discontinuation group (5.99 days) and the discontinuation and bridge heparin group (5.75 days) (p < 0.001).\u0000 \u0000 \u0000 \u0000 URL and fURS can be performed safely and effectively in patients on AC or AP drugs, resulting in reduced duration of hospital stay.\u0000","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141352640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Next-generation sequencing identifies the mutational signature of double primary and metastatic malignancies: A case report","authors":"Shiying Tang, Yixiao Deng, Yinan Yan, Jie Bai, Huiying He, Shudong Zhang, Jie Yang, Min Qiu, X. Tian","doi":"10.1097/cu9.0000000000000251","DOIUrl":"https://doi.org/10.1097/cu9.0000000000000251","url":null,"abstract":"\u0000 We present the case of a 59-year-old Chinese man diagnosed with stage III clear cell renal cell carcinoma who developed 2 suspicious lung lesions 5 years after follow-up. Pathological evaluation revealed 2 distinct types of cancer: lung adenocarcinoma in situ and clear cell renal carcinoma with lung metastasis. Lung tissue samples were sequenced using a panel of 1267 cancer-related genes. The analysis revealed completely different molecular profiles between the 2 lung lesions and similar clonal mutations in the superior lingular lobe and kidney. This indicates multiple metachronous primary tumors.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141362265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proficiency score as a predictor of early trifecta achievement during the learning curve of robot-assisted radical prostatectomy for high-risk prostate cancer: Results of a multicentric series.","authors":"Umberto Anceschi, Rocco Simone Flammia, Antonio Tufano, Michele Morelli, Antonio Galfano, Lorenzo Giuseppe Luciani, Leonardo Misuraca, Paolo Dell'Oglio, Gabriele Tuderti, Aldo Brassetti, Maria Consiglia Ferriero, Alfredo Maria Bove, Riccardo Mastroianni, Francesco Prata, Isabella Sperduti, Giovanni Petralia, Silvia Secco, Ettore Di Trapani, Daniele Mattevi, Tommaso Cai, Aldo Massimo Bocciardi, Giuseppe Simone","doi":"10.1097/CU9.0000000000000213","DOIUrl":"10.1097/CU9.0000000000000213","url":null,"abstract":"<p><strong>Background: </strong>Recently, an innovative tool called \"proficiency score\" was introduced to assess the learning curve for robot-assisted radical prostatectomy (RARP). However, the initial study only focused on patients with low-risk prostate cancer for whom pelvic lymph node dissection (PLND) was not required. To address this issue, we aimed to validate proficiency scores of a contemporary multicenter cohort of patients with high-risk prostate cancer treated with RARP plus extended PLND by trainee surgeons.</p><p><strong>Material and methods: </strong>Between 2010 and 2020, 4 Italian institutional prostate-cancer datasets were merged and queried for \"RARP\" and \"high-risk prostate cancer.\" High-risk prostate cancer was defined according to the most recent European Association of Urology guidelines as follows: prostate-specific antigen >20 ng/mL, International Society of Urological Pathology ≥4, and/or clinical stage (cT) ≥ 2c on preoperative imaging. The selected cohort (n = 144) included clinical cases performed by trainee surgeons (n = 4) after completing their RARP learning curve (50 procedures for low-risk prostate cancer). The outcome of interest, the proficiency score, was defined as the coexistence of all the following criteria: a comparable operation time to the interquartile range of the mentor surgeon at each center, absence of any significant perioperative complications Clavien-Dindo Grade 3-5, no perioperative blood transfusions, and negative surgical margins. A logistic binary regression model was built to identify the predictors of 1-year trifecta achievement in the trainee cohort. For all statistical analyses, a 2-sided <i>p</i> < 0.05 was considered significant.</p><p><strong>Results: </strong>A proficiency score was achieved in 42.3% patients. At univariable level, proficiency score was associated with 1-year trifecta achievement (odds ratio, 8.77; 95% confidence interval, 2.42-31.7; <i>p</i> = 0.001). After multivariable adjustments for age, nerve-sparing, and surgical technique, the proficiency score independently predicted 1-year trifecta achievement (odds ratio, 9.58; 95% confidence interval, 1.83-50.1; <i>p</i> = 0.007).</p><p><strong>Conclusions: </strong>Our findings support the use of proficiency scores in patients and require extended PLND in addition to RARP.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45315865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of incidence of acute kidney injury after robot-assisted radical prostatectomy with that after open retropubic and extraperitoneal laparoscopic radical prostatectomies in patients with prostate cancer.","authors":"Shunsuke Sato, Toshiaki Tanaka, Takeshi Maehana, Kohei Hashimoto, Ko Kobayashi, Naoya Masumori","doi":"10.1097/CU9.0000000000000216","DOIUrl":"10.1097/CU9.0000000000000216","url":null,"abstract":"<p><strong>Background: </strong>We retrospectively evaluated the postoperative renal function in patients who had undergone radical prostatectomy to compare the incidences of postoperative acute kidney injury (AKI) among the patients who had undergone robot-assisted radical prostatectomy (RARP), retropubic radical prostatectomy (RRP), and extraperitoneal laparoscopic radical prostatectomy (exLRP).</p><p><strong>Materials and methods: </strong>Patients with prostate cancer who had undergone radical prostatectomy at our institution between 2008 and 2014 were included. Robot-assisted radical prostatectomy was performed using an intraperitoneal approach in a 25-degree Trendelenburg position, whereas other procedures were performed with the patient in the supine position. We evaluated the serum creatinine levels and estimated glomerular filtration rates immediately after surgery and on postoperative day 1. We evaluated the incidence of AKI after prostatectomy using the Acute Kidney Injury Network criteria of the Kidney Disease: Improving Global Outcomes guidelines.</p><p><strong>Results: </strong>A total of 150 consecutive patients were included, with each of the 3 groups (RARP, RRP, and exLRP) comprising 50 patients. Postoperative AKI was observed in 15 (30.0%), 1 (2.0%), and 3 (6.0%) patients in the RARP, RRP, and exLRP groups, respectively. Stage 1 AKI was observed in all the patients except one. The incidence of AKI in RARP group was significantly higher than that in the other groups (<i>p</i> < 0.001). In the RARP group, the serum creatinine level was significantly elevated immediately after the surgery; however, it returned to baseline on postoperative day 1. Surgical procedures were the only independent factor associated with AKI incidence.</p><p><strong>Conclusions: </strong>This study suggest that compared with RRP and exLRP, RARP is associated with a higher incidence of postoperative AKI, although most patients recover rapidly. Intra-abdominal pneumoperitoneum may contribute to AKI onset.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11338007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44254988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which characteristics are associated with changes in medication status for lower urinary tract symptoms among patients with prostate cancer receiving external beam radiotherapy?","authors":"Yuki Kyoda, Kohei Hashimoto, Atsushi Takahashi, Takeshi Maehana, Kimihito Tachikawa, Takashi Muranaka, Shuichi Kato, Tomoyo Kurisu, Fumimasa Fukuta, Takahiro Kirisawa, Manabu Okada, Ko Kobayashi, Toshiaki Tanaka, Shiro Hinotsu, Naoya Masumori","doi":"10.1097/CU9.0000000000000194","DOIUrl":"10.1097/CU9.0000000000000194","url":null,"abstract":"<p><strong>Background: </strong>We clarified the predictive factors for changes in the status of medications for lower urinary tract symptoms (LUTS) 2 years after local radiotherapy for nonmetastatic prostate cancer.</p><p><strong>Materials and methods: </strong>We retrospectively included patients who underwent local external radiotherapy for nonmetastatic prostate cancer in 8 institutions between April 2001 and March 2016. Patients were divided into the medication and no-medication group based on the use of drugs for LUTS before radiotherapy. We defined improvement of LUTS as when the patient did not require medication for LUTS at 24 months after radiotherapy in the medication group and as deterioration when medication was required in the no-medication group. Logistic regression analysis was used to evaluate predictive factors for changes in medication status.</p><p><strong>Results: </strong>Altogether, 505 patients were divided into a no-medication group (n = 352) and a medication group (n = 153). The number of patients with deterioration and improvement in LUTS was 49 (14%) and 36 (23%), respectively. In the multivariate analysis, the predictive variables for deterioration were the International Prostate Symptom Score (≥8; odds ratio [OR], 2.21; <i>p</i> = 0.014) and the biopsy Gleason score (≤3 + 4 = 7; OR, 2.430; <i>p</i> = 0.008) in the no-medication group, whereas those for improvement were age (<75 years old; OR, 5.81; <i>p</i> = 0.002), the quality of life score (<3; OR, 3.15; <i>p</i> = 0.028), and a positive biopsy core rate (≥50%; OR, 2.530; <i>p</i> = 0.027) in the medication group.</p><p><strong>Conclusions: </strong>These predictive factors for changes in the status of medications for LUTS at 2 years after external radiotherapy may help determine the definitive therapy for nonmetastatic prostate cancer.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44491121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of persistent urine leak after partial nephrectomy: A case series.","authors":"Bakhman Guliev, Boris Komyakov, Maksim Shevnin, Murad Agagyulov, Ali Talyshinskii","doi":"10.1097/CU9.0000000000000136","DOIUrl":"10.1097/CU9.0000000000000136","url":null,"abstract":"<p><p>Urinary leak is one of the most significant complications after partial nephrectomy. In case of persistent urine leaks, placement of a ureteral stent is effective but not always sufficient. This study included 5 patients with persistent urinary leak after partial nephrectomy. The patients underwent flexible ureteroscopy wherein we identified the damaged calyx. Subsequently, we performed percutaneous puncture targeting the distal end of the endoscope at this calyx and installed a nephrostomy tube. Then, the endoscope was removed, and the ureter was drained with a stent. Ureteral stenting ensures elimination of urinary leak in most patients after partial nephrectomy. In patients with persistent urinary leak, retrograde endoscopic percutaneous drainage of the pelvicalyceal system is the method of choice because it allows for rapid and effective treatment of urinary fistulas.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11338002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44531163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of intermediate-risk prostate cancer with active surveillance in the routine care-Long-term outcomes of a prospective noninterventional study (HAROW).","authors":"Lothar Weissbach, Andreas Schwarte, Edith A Boedefeld, Jan Herden","doi":"10.1097/CU9.0000000000000203","DOIUrl":"10.1097/CU9.0000000000000203","url":null,"abstract":"<p><strong>Background: </strong>We report here the long-term outcomes of patients with intermediate-risk prostate cancer (PCa) treated with active surveillance (AS) in a daily routine setting.</p><p><strong>Material and methods: </strong>HAROW (2008-2013) was a noninterventional, health service research study investigating the management of localized PCa in a community setting. A substantial proportion of the study centers were office-based urologists. A follow-up examination of all intermediate-risk patients with AS was conducted. Overall, cancer-specific, metastasis-free, and treatment-free survival rates, as well as reasons for discontinuation, were determined and discussed.</p><p><strong>Results: </strong>Of the 2957 patients enrolled, 52 with intermediate-risk PCa were managed with AS and were available for evaluation. The median follow-up was 6.8 years (interquartile range, 3.4-8.6 years). Seven patients (13.5%) died of causes unrelated to PCa, of whom 4 were under AS or under watchful waiting. Two patients (3.8%) developed metastasis. The estimated 8-year overall, cancer-specific, metastasis-free, and treatment-free survival rates were 85% (95% confidence interval [CI], 72%-96%), 100%, 93% (95% CI, 82%-100%), and 31% (95% CI, 17%-45%), respectively. On multivariable analysis, prostate-specific antigen density of ≥0.2 ng/mL² was significantly predictive of receiving invasive treatment (hazard ratio, 3.29; <i>p</i> = 0.006). Reasons for discontinuation were more often due to patient's or physician's concerns (36%) than due to observed clinical progression.</p><p><strong>Conclusions: </strong>Although survival outcome data for intermediate-risk patients managed with AS in real-life health care conditions were promising, rates of discontinuation were high, and discontinuation was often a patient's decision, even when the signs of disease progression were absent. This might be an indication of higher levels of mental burden and anxiety in this specific subgroup of patients, which should be considered when making treatment decisions. From a psychological perspective, not all intermediate-risk patients are optimal candidates for AS.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46503623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of real-world data of frequent treatment sequences in metastatic prostate cancer.","authors":"Jiten Jaipuria, Ishleen Kaur, Mohammad Najmud Doja, Tanvir Ahmad, Amitabh Singh, Sudhir Kumar Rawal, Vineet Talwar, Girish Sharma","doi":"10.1097/CU9.0000000000000217","DOIUrl":"10.1097/CU9.0000000000000217","url":null,"abstract":"<p><strong>Background: </strong>The incidence of prostate cancer is increasing worldwide. A significant proportion of patients develop metastatic disease and are initially prescribed androgen deprivation therapy (ADT). However, subsequent sequences of treatments in real-world settings that may improve overall survival remain an area of active investigation.</p><p><strong>Materials and methods: </strong>Data were collected from 384 patients presenting with de novo metastatic prostate cancer from 2011 to 2015 at a tertiary cancer center. Patients were categorized into surviving (n = 232) and deceased (n = 152) groups at the end of 3 years. Modified sequence pattern mining techniques (Generalized Sequential Pattern Mining and Sequential Pattern Discovery using Equivalence Classes) were applied to determine the exact order of the most frequent sets of treatments in each group.</p><p><strong>Results: </strong>Degarelix, as the initial form of ADT, was uniquely in the surviving group. The sequence of ADT followed by abiraterone and docetaxel was uniquely associated with a higher 3-year overall survival. Orchiectomy followed by fosfestrol was found to have a unique niche among surviving patients with a long duration of response to the initial ADT. Patients who received chemotherapy followed by radiotherapy and those who received radiotherapy followed by chemotherapy were found more frequently in the deceased group.</p><p><strong>Conclusions: </strong>We identified unique treatment sequences among surviving and deceased patients at the end of 3 years. Degarelix should be the preferred form of ADT. Patients who received ADT followed by abiraterone and chemotherapy showed better results. Patients requiring palliative radiation and chemotherapy in any sequence were significantly more frequent in the deceased group, identifying the need to offer such patients the most efficacious agents and to target them in clinical trial design.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11338004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48494452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does a large prostate size, small lesion volume, or long needle distance from the probe to the lesion reduce magnetic resonance imaging-targeted cancer detection?","authors":"Mark D Bevill, Justin N Drobish, Kevin J Flynn, Maheen Rajput, Catherine Metz, Chad R Tracy, Paul T Gellhaus","doi":"10.1097/CU9.0000000000000171","DOIUrl":"10.1097/CU9.0000000000000171","url":null,"abstract":"<p><strong>Background: </strong>We aimed to evaluate whether large prostate size, small lesion volume, or long lesion distance from the ultrasound probe tip would decrease cancer detection in transrectal magnetic resonance imaging (MRI)-targeted biopsies.</p><p><strong>Materials and methods: </strong>Patients who underwent MRI-targeted biopsy at our institution between May 2017 and August 2019 were enrolled in a prospective database. Three to 5 cores were obtained from ≥2 prostate imaging reporting and data system v2 lesions. A multivariable model was created that included needle distance to the lesion, prostate specific antigen, prostate imaging reporting and data system, lesion volume, and prostate volume.</p><p><strong>Results: </strong>A total of 377 patients with 533 lesions underwent a biopsy during the study period. A total of 233 (44%) lesions were positive for prostate cancer, and 173 (32%) lesions had clinically significant prostate cancer. The mean needle distance to the lesion was 11.7 mm (interquartile range, 7.6-15.5 mm). The likelihood of obtaining a positive core on biopsy decreased as the distance from the ultrasound probe increased for all prostate cancers and clinically significant prostate cancer (<i>p</i> = 0.018 and <i>p</i> = 0.004, respectively). Every 10 mm from the rectum, there was an 8%-10% decrease in the rate of cancer detection. Similarly, as the prostate volume increased, the odds of obtaining a positive core also decreased (<i>p</i> = 0.039). There was no significant association between the lesion size and amount of cancer obtained on biopsy.</p><p><strong>Conclusions: </strong>Our data showed that transrectal MRI-targeted biopsy cancer detection modestly decreased the lesion from the ultrasound probe and with a large prostate volume but could not prove that lesion volume was a significant predictor of the amount of cancer detected.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47723966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of type and number of high-risk criteria with cancer-specific mortality in prostate cancer patients treated with radical prostatectomy.","authors":"Francesco Chierigo, Rocco Simone Flammia, Gabriele Sorce, Benedikt Hoeh, Lukas Hohenhorst, Andrea Panunzio, Zhe Tian, Fred Saad, Marcus Graefen, Michele Gallucci, Alberto Briganti, Francesco Montorsi, Felix K H Chun, Shahrokh F Shariat, Alessandro Antonelli, Giovanni Guano, Guglielmo Mantica, Marco Borghesi, Nazareno Suardi, Carlo Terrone, Pierre I Karakiewicz","doi":"10.1097/CU9.0000000000000188","DOIUrl":"10.1097/CU9.0000000000000188","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to test the association between of type and number of D'Amico high-risk criteria (DHRCs) with cancer-specific mortality (CSM) in high-risk prostate cancer patients treated with radical prostatectomy.</p><p><strong>Materials and methods: </strong>In the Surveillance, Epidemiology, and End Results database (2004-2016), we identified 31,281 radical prostatectomy patients with at least 1 DHRC, namely, prostate-specific antigen (PSA) >20 ng/mL (hrPSA), biopsy Gleason Grade Group (hrGGG) score of 4 and 5, or clinical tumor stage ≥T3 (hrcT). Multivariable Cox regression models and competing risks regression models (adjusting for other cause mortality) tested the association between DHRCs and 5-year CSM.</p><p><strong>Results: </strong>Of 31,281 patients, 14,394 (67%) exclusively harbored hrGGG, 3189 (15%) harbored hrPSA, and 1781 (8.2%) harbored hrcT. Only 2132 patients (6.8%) harbored a combination of the 2 DHRCs, and 138 (0.6%) had all 3 DHRCs. Five-year CSM rates ranged from 0.9% to 3.0% when any individual DHRC was present (hrcT, hrPSA, and hrGGG, in that order), 1.6% to 5.9% when 2 DHRCs were present (hrPSA-hrcT, hrcT-hrGGG, and hrPSA-hrGGG, in that order), and 8.1% when all 3 DHRCs were present. Cox regression models and competing risks regression confirmed the independent predictor status of DHRCs for 5-year CSM that was observed in univariable analyses, with hazard ratios from 1.00 to 2.83 for 1 DHRC, 2.35 to 5.88 for combinations of 2 DHRCs, and 7.13 for all 3 DHRCs.</p><p><strong>Conclusions: </strong>Within individual DHRCs, hrcT and hrPSA exhibited weaker effects than hrGGG did. Moreover, a dose-response effect was identified according to the number of DHRCs. Accordingly, the type and number of DHRCs allow further risk stratification within the high-risk subgroup.</p>","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48635757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}