Cuaj-Canadian Urological Association Journal最新文献

{"title":"Public awareness of testicular torsion is lacking in Edmonton.","authors":"Neel Phaterpekar, Darcie Kiddoo, Daniel Keefe, Sana Samadi, Troy Turner, Peter Metcalfe","doi":"10.5489/cuaj.9066","DOIUrl":"10.5489/cuaj.9066","url":null,"abstract":"<p><strong>Introduction: </strong>The time from symptom onset to intervention dictates morbidity in testicular torsion (TT). Delayed presentation negatively impacts surgical outcomes and poor knowledge about TT is hypothesized to be a potential cause of delay. Our study characterizes baseline public awareness rates among families in Edmonton and assesses the association between awareness and TT outcomes.</p><p><strong>Methods: </strong>Patients and their caregivers completed surveys assessing TT awareness. Families were surveyed in two groups: those who presented with TT and age-matched controls. Affected families gave additional information about symptoms, time to notify parents, and present to the hospital. Outcomes were assessed at followup and through medical record review.</p><p><strong>Results: </strong>Of 61 families, 18 (29.5%) patients and 22 (36.1%) parents had heard of TT. Among TT-affected patients (n=30), time to report symptoms (3.2 vs. 20.5 hours, p<0.01) and to arrive at hospital (3.0 vs. 20.8 hours, p<0.01) was significantly longer for patients requiring orchiectomy. Total time (odds ratio [OR] 0.992, p=0.01) and pain (OR 0.904, p=0.05) were associated with outcome. No differences in awareness were seen between patients who underwent orchiopexy vs. orchiectomy (23.8% vs. 25.0%, p>0.99).</p><p><strong>Conclusions: </strong>We demonstrate that most Edmonton families have never heard of TT and that the pre-admission interval constitutes a substantial proportion of delays in surgery. Although time and pain ratings were associated with outcomes in TT, further evidence is required to demonstrate that awareness impacts outcomes significantly.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E301-E306"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112574","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":"Association of surgical margin positivity with preoperative mpMRI-identified index lesions in radical prostatectomy A retrospective study.","authors":"Ahmet Halis, Mucahit Gelmis, Ufuk Caglar, Ibrahim Hacibey, Sami Sekkeli, Huseyin Burak Yazılı, Ali Ayranci, Faruk Ozgor","doi":"10.5489/cuaj.9103","DOIUrl":"10.5489/cuaj.9103","url":null,"abstract":"<p><strong>Introduction: </strong>Prostate cancer remains the second most common malignancy in men worldwide. Positive surgical margins (PSMs) following radical prostatectomy are associated with an increased risk of biochemical recurrence. This study investigated the relationship between preoperative multiparametric magnetic resonance imaging (mpMRI)-detected index lesions and PSMs, aiming to assess whether specific lesion locations correlate with margin involvement.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at Health Sciences University Haseki Training and Research Hospital, analyzing 148 patients who underwent radical prostatectomy between 2017 and 2023. Patients were stratified based on surgical margin status, with comparisons made between mpMRI features, pathologic outcomes, and the anatomical distribution of PSMs. Binary logistic regression was used to identify independent predictors of PSMs.</p><p><strong>Results: </strong>Of the 148 patients, 49 had PSMs. Higher preoperative prostate-specific antigen levels, prostate-specific antigen density, and Prostate Imaging-Reporting and Data System (PI-RADS) scores were significantly associated with PSMs. Multivariate analysis revealed that PI-RADS 5, International Society of Urological Pathology grade 4 or above, and extraprostatic extension were independent predictors of PSMs. Although lesions in the apical and posterior regions showed higher rates of PSMs, the regional differences were not statistically significant.</p><p><strong>Conclusions: </strong>Our findings suggest that mpMRI plays a critical role in preoperative risk stratification and may guide surgical planning to reduce PSMs; however, further prospective studies are needed to validate these results and explore the potential benefits of targeted resections in high-risk regions for improving oncologic outcomes.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E312-E316"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112343","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":"Prostate-specific antigen density does not predict metastatic disease on PSMA-PET in high-risk prostate cancer patients with negative conventional imaging.","authors":"Ravi Kumar, Katherine Lajkosz, Ur Metser, Jimmy Misurka, Jenna Hiemstra, Jayson Kreidstein, Lauren Calicchia, Amalia Silberman, Antonio Finelli, Neil E Fleshner, Robert J Hamilton, Girish S Kulkarni, Alexandre Zlotta, Alejandro Berlin, Nathan Perlis","doi":"10.5489/cuaj.9113","DOIUrl":"10.5489/cuaj.9113","url":null,"abstract":"<p><strong>Introduction: </strong>The ability of prostate-specific antigen density (PSAD) to predict metastatic disease on prostate-specific membrane antigen-positron emission tomography (PSMA-PET) at initial staging in high-risk prostate cancer (PCa) for men with negative conventional imaging is unclear. We hypothesized that there might be a PSAD cutoff below which PSMA-PET would be unnecessary, as it would so rarely identify metastatic disease.</p><p><strong>Methods: </strong>A retrospective cohort study of all men receiving ¹⁸F-DCFPyl PSMA-PET for primary staging between January 2018 and December 2022 at the University Health Network was performed. Student's t-tests or Mann-Whitney U tests were used to compare continuous variables by PSMA-PET positivity status. Receiver operating characteristic curve analysis to compare PSA and PSAD performance and Chi-squared automatic interaction detector methodologies were used to identify predictors of metastatic disease.</p><p><strong>Results: </strong>A total of 140 men with high-risk PCa and negative conventional imaging were included. The median age was 68 years (interquartile range [IQR] 63-74). Median PSA and PSAD were 13.9 (IQR 6.9-29.5) and 0.36 ng/ml² (IQR 0.19-0.83), respectively. PSMA-PET was positive in 40% of cases for metastatic disease. The area under the curve (AUC) to predict metastatic disease on PSMA-PET was 0.55 for PSAD (p=0.57). Patients with metastatic disease on PSMA-PET had higher Gleason grade group (GG) scores on biopsy (53 vs. 20% GG5, p<0.001) and more extraprostatic extension (19 vs. 6%, p=0.03) and perineural invasion (65 vs. 45%, p=0.03).</p><p><strong>Conclusions: </strong>In this retrospective cohort, PSAD does not reliably predict which patients with high-risk PCa and negative conventional imaging will have metastatic disease unveiled by PSMA-PET.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E307-E311"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112464","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":"A multidisciplinary evaluation of fertility preservation for oncology patients in Canada: The British Columbia perspective.","authors":"Regina-Veronicka Kalaydina, Kiera Liblik, Amy Dhillon, Kristin Marr, Karen Goddard, Alannah Smrke, A Fuchsia Howard, Stuart Peacock, Julie Wong, Luke Witherspoon, Ryan Flannigan","doi":"10.5489/cuaj.9215","DOIUrl":"https://doi.org/10.5489/cuaj.9215","url":null,"abstract":"<p><strong>Introduction: </strong>Infertility represents a devastating side effect of antineoplastic agents, particularly in adolescents and young adults (AYA). A paucity of practitioner-initiated fertility preservation (FP) counseling has resulted in low uptake of assisted reproductive technologies. There is no dedicated FP program in British Columbia (BC) and few across Canada, leaving patients without adequate support. This study aimed to identify, analyze, and prioritize the FP needs of BC oncology patients, predominantly AYAs, according to healthcare providers.</p><p><strong>Methods: </strong>An online survey developed by a multidisciplinary team was distributed to practitioners across the British Columbia Cancer Network from March to September 2023. Survey data were analyzed descriptively.</p><p><strong>Results: </strong>Overall, our survey response rate was 74.2%. Of 120 responses recorded in total, 89 - from 27 oncologists, 58 nurses/nurse practitioners, two family physicians, one fertility specialist, and one care aide - were included in the analysis While 43.6% of respondents indicated that their patients were likely to be impacted by treatment-related infertility, only 26.8% reported that their patients are usually referred to FP services, and 45.7% reported that their patients receive fertility counseling. Barriers to FP counseling included competing priorities, appointment length, lack of clinical knowledge, urgency to start treatment, perceived futility of FP, and perceived lack of financial resources. Facilitators of FP discussions were awareness, education, financial assistance, provider-initiated discussions, knowledgeable providers, and locally dedicated FP programs.</p><p><strong>Conclusions: </strong>This study represents the first characterization of interdisciplinary provider practices and beliefs surrounding FP among oncology patients in BC, highlighting the need for an FP program to improve patient care and quality of life. This data can be leveraged nationwide to inform the development and evolution of FP programs for this critically underserved patient population.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976768","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":"Healthcare utilization by patients with primary hyperparathyroidism: What is the effect of kidney stone formation?","authors":"Kieran J Moore, Joshua White, Kara Matheson, Karthik Tennankore, Stephanie Kaiser, Matthew Rigby, Andrea G Lantz Powers","doi":"10.5489/cuaj.9227","DOIUrl":"https://doi.org/10.5489/cuaj.9227","url":null,"abstract":"<p><strong>Introduction: </strong>Urolithiasis is a common complication of primary hyperparathyroidism (PHPT). Parathyroidectomy has been shown to decrease the rate of stone formation. The purpose of this study was to evaluate healthcare resource utilization before and after parathyroidectomy and identify predictors of increased healthcare utilization.</p><p><strong>Methods: </strong>A retrospective analysis of patients who had a parathyroidectomy for PHPT in Nova Scotia from 2013-2018 was performed. Data from five years before parathyroidectomy to three years after were included. Outcomes included emergency department (ED) visits and the number of urologic interventions. Random-effects Poisson regression models were used to calculate the primary outcomes, ED visits, and the number of urologic interventions while adjusting for prespecified characteristics.</p><p><strong>Results: </strong>Fifty patients (62% female) with a mean age of 60±11 years were identified. ED visits were 0.42 per year before parathyroidectomy and 0.20 per year after in a multivariate analysis (incidence rate ratio [IRR] 0.48, confidence interval [CI] 0.25-0.91, p=0.024). There was no statistical difference between male and female ED visits (p=0.6719). There was no difference in the rate of ED visits for non-urologic reasons after parathyroidectomy (p=0.0749). The incidence of urologic intervention for stones was 1.24 per year before parathyroidectomy and 0.53 per year after (IRR 0.42, CI 0.26-0.68, p=0.0005).</p><p><strong>Conclusions: </strong>Healthcare resource utilization, in terms of ED visits and urologic intervention significantly decreased after parathyroidectomy. Sex showed no statistical difference in predicting healthcare utilization, while non-urologic ED visits remained the same after surgery. Expedited parathyroidectomy for PHPT patients may decrease urologic interventions and ED visits, resulting in less healthcare utilization.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977037","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":"Evaluating the cost-effectiveness of the Prostate Cancer Patient Empowerment Program: A comprehensive health economic analysis from a randomized controlled trial.","authors":"Alexandra Nuyens, Gabriela Ilie, Ricardo A Rendon, Ross J Mason, Mohammad Hajizadeh, Prosper Senyo Koto, Martha Foley, Andrea Kokorovic, Nikhilesh Patil, David Bowes, Greg Bailly, Derek Wilke, Cody MacDonald, Robert David Harold Rutledge","doi":"10.5489/cuaj.9222","DOIUrl":"https://doi.org/10.5489/cuaj.9222","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to evaluate the cost-effectiveness of the Prostate Cancer Patient Empowerment Program (PC-PEP), a six-month comprehensive intervention designed to enhance psychological well-being and reduce healthcare expenditures among prostate cancer patients.</p><p><strong>Methods: </strong>In a crossover randomized clinical trial of 128 men aged 50-82 years scheduled for curative prostate cancer surgery or radiotherapy (± hormone treatment), 66 men received the PC-PEP intervention immediately, while 62 were randomized to a waitlist-control arm and received standard care for six months before receiving PC-PEP. The intervention included daily activities targeting physical fitness, pelvic floor training, stress management, intimacy, social support, and dietary guidance. Cost-effectiveness was assessed from a healthcare payer perspective using billing data from Nova Scotia's Medical Services Insurance (MSI) and self-reported outcomes. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were calculated using bootstrapped samples. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10), while quality-adjusted life years (QALYs) were estimated from SF-6D utility scores.</p><p><strong>Results: </strong>PC-PEP resulted in cost savings of $411.53 CAD per patient at six months, with a 30% reduction in clinically significant psychological distress and a QALY gain of 0.013. At 12 months, savings increased to $660.89 CAD per patient, preventing 31% of distress cases and yielding a QALY gain of 0.034. These outcomes demonstrate that PC-PEP is a dominant intervention, achieving both improved clinical outcomes and reduced healthcare expenditures.</p><p><strong>Conclusions: </strong>PC-PEP is a dominant, cost-effective strategy that significantly improves psychological well-being while lowering healthcare costs. Early implementation following prostate cancer diagnosis is strongly recommended to maximize both clinical and economic benefits.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976911","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":"A population-based analysis of patterns of care in patients with de novo muscle-invasive bladder cancer from Alberta, Canada.","authors":"Nimira S Alimohamed, Geoffrey Gotto, Girish S Kulkarni, Peter C Black, Wassim Kassouf, Srikala S Sridhar, Andrea Kokorovic, Bernhard J Eigl, Normand Blais, Aly-Khan A Lalani, Winson Y Cheung, Mariet Stephen, Brendan J W Osborne, Christopher J D Wallis","doi":"10.5489/cuaj.9111","DOIUrl":"https://doi.org/10.5489/cuaj.9111","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 25% of patients diagnosed with bladder cancer have muscle-invasive disease (MIBC). While real-world data have highlighted opportunities to improve curative-intent treatment rates, comprehensive population-level data in Canada are limited. This study aimed to assess patterns of care and outcomes in a real-world cohort of MIBC in Canada.</p><p><strong>Methods: </strong>This retrospective, observational study describes baseline characteristics, treatment patterns, and overall survival (OS) of individuals with de novo MIBC diagnosed between 2010 and 2020 in Alberta, Canada. Data from adult patients with MIBC (T2-4N0-1M0) were obtained from administrative databases and analyzed using basic statistics, multivariate regression analyses, and the Kaplan-Meier method.</p><p><strong>Results: </strong>We identified 1292 patients with de novo MIBC. Of these, 76% were male with a median age of 73 years, 68% had cT2, and 76% had cN0 disease; approximately half had a Charlson comorbidity index (CCI) ≥1. Overall, 25% did not receive active treatment while 58% received curative-intent treatment (49% underwent radical cystectomy [RC] and 9% received chemoradiotherapy) and 17% received some form of non-curative-intent treatment. Of those who underwent RC, 45% received neoadjuvant chemotherapy (NAC). Median overall survival (mOS) in the entire cohort was 2.1 years (95% confidence interval 1.9-2.4). Key predictors of inferior survival were age ≥76 years, CCI score of ≥1, T4 tumor stage, or not receiving NAC.</p><p><strong>Conclusions: </strong>This real-world analysis highlights opportunities to improve outcomes for patients with MIBC. Increasing access to curative-intent treatments, particularly in the elderly and those with comorbidities, is likely to enhance patient care and outcomes.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976819","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":"Assessing the methodologic quality of systematic reviews using generative large language models.","authors":"Bowen Yao, Onuralp Ergun, Maylynn Ding, Carly D Miller, Vikram M Narayan, Philipp Dahm","doi":"10.5489/cuaj.9243","DOIUrl":"https://doi.org/10.5489/cuaj.9243","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to evaluate whether generative large language models (LLMs) can accurately assess the methodologic quality of systematic reviews (SRs).</p><p><strong>Methods: </strong>A total of 114 SRs from five leading urology journals were included in the study. Human reviewers graded each of the SRs in duplicates, with differences adjudicated by a third expert. We created a customized GPT \"Urology AMSTAR 2 Quality Assessor\" and graded the 114 SRs in three iterations using a zero-shot method. We performed an enhanced trial focusing on critical criteria by giving GPT detailed, step-by-step instructions for each of the SRs using chain-of-thought method. Accuracy, sensitivity, specificity, and F1 score for each GPT trial was calculated against human results. Internal validity among three trials were computed.</p><p><strong>Results: </strong>GPT had an overall congruence of 75%, with 77% in critical criteria and 73% in non-critical criteria when compared to human results. The average F1 score was 0.66. There was a high internal validity at 85% among three iterations. GPT accurately assigned 89% of studies into the correct overall category. When given specific, step-by-step instructions, congruence of critical criteria improved to 91%, and overall quality assessment accuracy to 93%.</p><p><strong>Conclusions: </strong>GPT showed promising ability to efficiently and accurately assess the quality of SRs in urology.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976921","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":"Examining the association between real-world extended vs. standard pelvic lymph node dissection and early and late oncologic outcomes in men undergoing radical prostatectomy.","authors":"Wyatt MacNevin, Sandra Seo Young Kim, Ricardo A Rendon, Hamidreza Abdi, Rodney H Breau, Jonathan Izawa, Fred Saad, Alan I So, Bobby Shayegan, Ross J Mason","doi":"10.5489/cuaj.9213","DOIUrl":"https://doi.org/10.5489/cuaj.9213","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with prostate cancer (PCa), the impact of extended pelvic lymph node dissection (E-PLND) during radical prostatectomy (RP) on oncologic outcomes remains controversial. This study examined the association between extended vs. standard PLND (S-PLND) and biochemical recurrence (BCR), an early outcome, as well as metastatic PCa (mPCa), and castration-resistant PCa (CRPC) development, late outcomes, in a multi-institutional cohort.</p><p><strong>Methods: </strong>High-risk post-RP patients from a Canadian PCa database were analyzed from January 1, 2005, to December 31, 2016. The association between PLND and BCR, mPCa, CRPC-development, and complication rate were examined using regression and correlation analysis.</p><p><strong>Results: </strong>Data were collected on patients who underwent S-PLND (n=494) and E-PLND (n=107). The median followup was 40.1 months, and time to BCR, mPC, and CRPC-development was 9.8, 46.0, and 52.1 months, respectively. The median (interquartile range) number of lymph nodes extirpated was 7 (7) and 14 (11) for the S-PLND and E-PLND groups, respectively. E-PLND was associated with increased intraoperative blood loss and higher postoperative complication rate. There were no differences in BCR-free survival based on PLND approach, with 67.1% of S-PLND cases and 71.1% of E-PLND cases reaching BCR-free survival at the end of the followup period (hazard ratio [HR] 0.784 [0.506, 1.215], p=0.28). PLND extent was not a predictor for mPCa progression (p=0.963). Similarly, there were no differences in CRPC-free survival based on dissection type (S-PLND 90.9% vs. E-PLND 89.1%, p=0.561). LN positivity was predictive of BCR, mPCa, and CRPC progression.</p><p><strong>Conclusions: </strong>E-PLND did not show significant differences in the rates of BCR, mPCa, or CRPC progression when compared to S-PLND. E-PLND was associated with higher complication rates. This study adds to the data exploring the association between PLND and PCa oncologic outcomes.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977043","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":"Testosterone replacement therapy and bladder cancer.","authors":"Mikael F Kanaan, Rodney H Breau, Luke T Lavallée, Daniel I McIsaac, Luke Witherspoon","doi":"10.5489/cuaj.9207","DOIUrl":"https://doi.org/10.5489/cuaj.9207","url":null,"abstract":"<p><p>Muscle-invasive bladder cancer is a common malignancy, and its standard of care treatment often involves neoadjuvant chemotherapy and radical cystectomy. These treatments are invasive and associated with significant mortality and morbidity. Neoadjuvant chemotherapy is associated with skeletal muscle atrophy and reduced body mass, while radical cystectomy is associated with high-risk blood loss necessitating blood transfusion. Despite an established relationship between androgens and prostate cancer, it is unclear whether androgens impact other types of cancer, including bladder cancer. In fact, decades of research on the relationship between anti-androgens and cancer prevention/treatment have provided conflicting or inconclusive results. Preoperative testosterone could prevent surgery-related skeletal muscle atrophy and help maintain normal hematocrit levels. Preoperative testosterone is an inexpensive and feasible intervention and seems to improve postoperative recovery with minimal adverse effects in different patient populations. To date, no clinical trial has been conducted evaluating preoperative testosterone in bladder cancer patients. In this review, we present a rationale for the use of preoperative testosterone in bladder cancer patients, which we believe may serve as the basis for the development of a future clinical trial.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977086","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}