BJU International最新文献

{"title":"Comment on 'Long-term multicentre analysis of robot-assisted radical cystectomy for non-muscle-invasive bladder cancer'.","authors":"G S Chethan, N S Patil","doi":"10.1111/bju.70313","DOIUrl":"https://doi.org/10.1111/bju.70313","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urologist and radiologist contributions to variation in prostate cancer detection at fusion biopsy.","authors":"Daniel Triner, Kevin B Ginsburg, Ana Moser, Corinne Labardee, Howard Korman, Jason Domina, Michael L Cher, James Peabody, Alice Semerjian, Andrei Purysko, Arvin K George, Tudor Borza, Andrew E Krumm","doi":"10.1111/bju.70308","DOIUrl":"https://doi.org/10.1111/bju.70308","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify the relative contribution of radiologists and urologists to variability in clinically significant prostate cancer (CSPC) detection across multiparametric magnetic resonance imaging (mpMRI)-guided prostate fusion biopsies and to determine whether this differed across Prostate Imaging-Reporting And Data System (PI-RADS) categories.</p><p><strong>Subjects, patients and methods: </strong>We analysed biopsy-naïve men within the Michigan Urological Surgery Improvement Collaborative (MUSIC) who underwent fusion biopsy between August 2017 and November 2021. The primary outcome was the proportion of variance in CSPC detection (Gleason score ≥3 + 4) at targeted regions of interest that was explained by individual urologists and radiologists. We used generalised linear mixed-effects models to partition variance and estimate intraclass correlation coefficients (ICCs) for radiologist- and urologist-level effects for PI-RADS score 3-5 lesions. We calculated the median odds ratio (MOR) to quantify the expected difference in odds of CSPC detection when comparing a randomly selected higher- vs lower-detecting provider from the same distribution.</p><p><strong>Results: </strong>Among 1544 men with 2045 targeted lesions, mpMRIs were interpreted by 115 radiologists and biopsies performed by 86 urologists. For PI-RADS score 3 lesions, urologists (ICC = 0.15, MOR = 2.07) accounted for greater variance in CSPC detection than radiologists (ICC = 0.07, MOR = 1.61). For PI-RADS score 4, both urologist (ICC = 0.05, MOR = 1.49) and radiologist (ICC = 0.07, MOR = 1.61) contributed modestly. For PI-RADS score 5, radiologists (ICC = 0.17, MOR = 2.19) explained a larger proportion of variance than urologists (ICC = 0.01, MOR = 1.19), suggesting individual radiologists meaningfully impact CSPC detection of high-risk lesions.</p><p><strong>Conclusions: </strong>For PI-RADS score 3 lesions, the specific urologist performing the biopsy was a strong source of variation, while for PI-RADS score 5 lesions, the radiologist had greater influence on CSPC detection rates. Optimising MRI acquisition and interpretation, ensuring accurate fusion registration, and improving biopsy accuracy are critical to improving diagnostic consistency.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiparametric MRI in prostate cancer active surveillance: results from the Miami Active Surveillance Trial (MAST) trial.","authors":"Seyed Hossein Hosseini Sharifi, Adam Williams, Jonathan T Ryan, Tarek Ajami, Omri Falik Nativ, Sunwoo Han, Isildinha M Reis, Nachiketh Soodana-Prakash, Archan Khandekar, Sanjaya Swain, Oleksandr N Kryvenko, Radka Stoyanova, Alan Pollack, Patricia R Castillo, Bruno Nahar, Chad R Ritch, Bruce Kava, Mark L Gonzalgo, Dipen J Parekh, Sanoj Punnen","doi":"10.1111/bju.70303","DOIUrl":"https://doi.org/10.1111/bju.70303","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the role of multiparametric magnetic resonance imaging (mpMRI) in enhancing prostate cancer (PCa) detection and selecting candidates for active surveillance (AS), given that its utility in monitoring disease progression remains unclear.</p><p><strong>Patients and methods: </strong>The Miami Active Surveillance Trial (MAST) is a prospective trial of men undergoing serial mpMRI and biopsies on AS for PCa. Participants had annual mpMRI with MRI-targeted and systematic biopsies at confirmatory (12-18 months) and subsequent intervals (12, 24, and 36 months). Grade progression was defined as an upgrade from Grade Group (GG) 1 to GG ≥2 or GG 2 to GG ≥3. The performance of MRI was evaluated at baseline (prior to confirmatory biopsy) and on subsequent biopsies for association with grade progression. Fine and Gray competing-risk models evaluated MRI for predicting grade progression after controlling for risk factors.</p><p><strong>Results: </strong>Among 205 men, 79 (38.5%) had grade progression at the conclusion of the trial (36 months), with 40 (19.5%) men having grade progression at confirmatory biopsy, and the remaining 39 (2.0-9.8%/year) progressing on subsequent biopsies. A Prostate Imaging-Reporting And Data System (PI-RADS) score of 4 or 5 (vs no suspicious lesions or PI-RADS 1 and 2) on baseline MRI (prior to confirmatory biopsy) was an independent predictor of grade progression on confirmatory biopsy (Gray's test P < 0.001), with volume progression treated as a competing risk. At 36 months, MRI-only surveillance would have avoided 45% of biopsies but missed 32% of progression events.</p><p><strong>Conclusion: </strong>Pre-confirmatory biopsy MRI independently predicted grade progression on confirmatory and subsequent biopsies during AS; however, false positives and negatives still occur highlighting the need for periodic biopsy of the prostate.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytoreductive nephrectomy in the era of immune-checkpoint inhibitors: back to the future?","authors":"Rocco Simone Flammia, Riccardo Campi, Eugenio Bologna, Riccardo Bertolo, Costantino Leonardo, Fabio Calabrò, Daniele Amparore, Giuseppe Simone","doi":"10.1111/bju.70168","DOIUrl":"10.1111/bju.70168","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) treated with immune-checkpoint inhibitors (ICIs).</p><p><strong>Methods: </strong>A narrative review was carried out using PubMed and searching for English articles published from January 2015 to May 2025.</p><p><strong>Results: </strong>After the screening process, 12 retrospective studies comparing outcomes in patients with mRCC treated with ICI-based regimens, with or without CN (either upfront or deferred) were deemed eligible. Of those, six indicated a survival benefit for patients undergoing CN in combination with ICIs with hazards ratios ranging from 0.19 to 0.63, a finding that remains consistent within the upfront CN subgroup. However, the included studies' retrospective nature, inherent selection, and immortal time biases limit definitive conclusions. Ongoing phase III randomised trials, NORDIC-SUN (ClinicalTrials.gov identifier: NCT03977571) and Southwest Oncology Group (SWOG)-1931 (also known as PROBE; NCT04510597), are evaluating the role of deferred CN after initial ICI therapy, while the role of upfront CN in the ICI era will be likely elucidated by SEVURO-CN (NCT05753839) trial.</p><p><strong>Conclusion: </strong>Our findings highlight reconsidering the importance of CN in the ICI era, potentially driven by the influence of tumour burden on anti-cancer immunity and the limited efficacy of ICIs against primary tumours. Future research, ideally through randomised trials involving patients suitable for safe surgery, should aim to clarify the optimal timing of CN in the context of ICI therapy.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"763-769"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction Analysis of Microarray of 50 genes (PAM50) classifier validated for predicting prostate cancer progression in active surveillance: Miami Active Surveillance Trial (MAST).","authors":"Ankur Malpani, Jonathan T Ryan, Hui Yu, Nachiketh Soodana-Prakash, Archan Khandekar, Tarek Ajami, Adam Williams, Zoe Szczotka, Mohammed Alshalalfa, Yangyang Hao, Elai Davicioni, Sanjaya Swain, Oleksandr N Kryvenko, Alan Dal Pra, Radka Stoyanova, Sandra Gaston, Alan Pollack, Brandon A Mahal, Matthew Abramowitz, Bruno Nahar, Chad R Ritch, Bruce Kava, Mark L Gonzalgo, Dipen J Parekh, Sanoj Punnen","doi":"10.1111/bju.70202","DOIUrl":"10.1111/bju.70202","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate basal-luminal cell of origin subtyping using Prediction Analysis of Microarray of 50 genes (PAM50) genomic classification profiles for predicting disease progression in men undergoing active surveillance (AS) for prostate cancer (PCa).</p><p><strong>Patients and methods: </strong>In the prospective Miami Active Surveillance Trial (MAST) trial, 205 men undergoing AS received serial multiparametric magnetic resonance imaging (MRI) and biopsies, including MRI-targeted and systematic sampling. The highest-grade core from each biopsy was sent for expression profiling using Decipher, a clinical-grade transcriptome assay (Veracyte Inc., San Diego, CA, USA). Basal-luminal subtyping was evaluated using PAM50 molecular subtype models. PCa grade progression was compared across subtypes, as were gene mutation signatures, prognostic indices, and pathway activities. Kaplan-Meier curves, log-rank test, and multivariable Cox regression were used to assess association between PAM50 and grade progression. Heatmaps and volcano plots were rendered to illustrate potential mechanistical differences between PAM50 subtypes.</p><p><strong>Results: </strong>Of the 205 patients, 128 had transcriptome data for baseline basal-luminal classification. PAM50 identified 46 Luminal A (LA), 26 Luminal B (LB), and 56 Basal subtypes. Decipher scores were lowest in LA, followed by Basal, and highest in LB. Grade progression-free survival was worse in patients with the LB subtype (median 1.7 years) compared to those with LA and Basal subtypes (median 2.9 years; log-rank P = 0.005); LB patients had grade progression-free survival of 34% by 24 months of AS, compared to 63% for Basal or 68% for LA. Transcriptome analysis showed distinct enrichment profiles for each subtype, with LB strongly associated with SPOP and CHD1 mutations. Limitations include small sample size and single-institution setting.</p><p><strong>Conclusion: </strong>The PAM50 basal-luminal subtyping shows promise as a molecular classification tool for predicting progression risk in PCa. This is one of the only prospective studies evaluating PAM50 subtyping for predicting cancer progression in a cohort of men undergoing AS for PCa.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"886-894"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147302158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond sensitivity: artificial intelligence and micro-ultrasonography in prostate cancer detection.","authors":"Tirayut Veerasatian, Patpicha Arunsan, Schawanya K Rattanapitoon, Nathkapach K Rattanapitoon","doi":"10.1111/bju.70112","DOIUrl":"10.1111/bju.70112","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"922"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146163928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in medical and surgical management of urologic cancers.","authors":"","doi":"10.1111/bju.70284","DOIUrl":"https://doi.org/10.1111/bju.70284","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"12 1","pages":"748-749"},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in urology training: practical benefits and real-world limits.","authors":"Stamatios Katsimperis, Ioannis Kyriazis, Panagiotis Neofytou, Sotirios Kapsalos, Polyvios Arseniou","doi":"10.1111/bju.70205","DOIUrl":"10.1111/bju.70205","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"753-754"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147302106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes of men presenting with complications of metastatic prostate cancer.","authors":"Arjun Nathan, Matthew G Parry, Adrian Cook, Emily Mayne, Joanna Dodkins, Marina Parry, Raghav Varma, Ajay Aggarwal, Jan van der Meulen, James S A Green, Alison Tree, Noel Clarke, Thomas E Cowling","doi":"10.1111/bju.70179","DOIUrl":"10.1111/bju.70179","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the incidence, characteristics and mortality of men who present with complications of metastatic prostate cancer, a previously under-reported population. We investigate men who present with and without malignant ureteric obstruction (MUO) and skeletal-related events (SREs), collectively termed 'metastatic-related events' (MREs).</p><p><strong>Patients and methods: </strong>We used the English Cancer Registry linked to hospital administrative data to identify men diagnosed with metastatic prostate cancer between January 2015 and December 2022. Poisson regression models estimated adjusted relative risks (aRRs) of presenting with MREs. The cumulative incidences of overall and prostate cancer-specific death were estimated for each MRE subgroup (metastatic without MRE, MUO, SRE, and MUO and SRE in combination).</p><p><strong>Results: </strong>Of 48 171 men diagnosed with primary metastatic disease, 4272 (8.9%) presented with MREs. Of these men, 2453 (57.4%) had MUO, 1738 (40.7%) had a SRE, and 81 (1.9%) had both. Men aged ≥80 years had the highest risk (9.8% [1604/16452]) of presenting with MREs. Men aged 70-79 years (8.0% [1470/18397]) (aRR 0.82, 95% confidence interval [CI] 0.77-0.88) and men aged 60-69 years (8.9% [916/10297]) (aRR 0.91, 95%CI 0.84-0.98) had lower risks. Men from the most deprived neighbourhoods (9.3% [706/7609]) (aRR 1.27, 95% CI 1.15-1.40) had greater risks of presenting with MREs than those from the least deprived neighbourhoods (8.0% [868/10865]). The proportion of men presenting with MREs varied across geographical regions, ranging from 4.6% (288/6233) to 11.7% (461/3951). The 5-year overall mortality for men presenting without MREs was 57.8% (95% CI 57.2-58.4%), compared to 77.1% (95% CI 74.9-79.2%) with MUO, 66.8% (95% CI 64.1-69.4%) with a SRE and 84.4% (95% CI 74.1-94.7%) with both.</p><p><strong>Conclusions: </strong>The risk of presenting with metastatic prostate cancer and MREs varies according to age, socioeconomic deprivation, and residential region. These men have poorer survival outcomes than men diagnosed without MREs at diagnosis.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"840-848"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146212037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of age and the presence of prostate cancer on prostate volume, PSA and PSA density.","authors":"Jill Rusbridge, Iztok Caglic, Liness Thavaraja, Nikita Sushentsev, Tristan Barrett","doi":"10.1111/bju.70169","DOIUrl":"10.1111/bju.70169","url":null,"abstract":"<p><strong>Objective: </strong>To assess prostate volume (PV) changes with age in symptomatic and asymptomatic men with and without clinically significant prostate cancer (csPCa). In symptomatic patients, we additionally analysed the effect of age and csPCa on PSA and PSA-density (PSA-D) and compared these to current National Institute for Health and Care Excellence (NICE) recommended PSA age-range thresholds. Patients and Methods This single-centre retrospective cross-sectional study included 2512 men: 760 asymptomatic, disease-free men and 1752 patients referred on a PCa diagnostic pathway. Magnetic resonance imaging-derived whole-gland PV was recorded for all patients. A machine-learning pipeline with k-fold cross validation modelled relationships between PV and age.</p><p><strong>Results: </strong>In asymptomatic men (median PV 25.4 mL), the mean PV per age-group increased non-linearly with age, from 18.7 mL at an increase of 0.10 mL/year aged 18 years, to 41.3 mL at 0.68 mL/year aged 89 years, with increased rate of change from the age of 48.9 years. Significant positive relationships were shown between PSA and age in patients with and without csPCa (r² = 0.09 vs 0.13, respectively), with PSA increasing by mean 0.17 ng/mL/year across groups. Patients with csPCa had consistently higher PSA levels. PSA-D showed significant age-related linear increases in patients with csPCa but remained consistently lower in those without csPCa at all ages (0.10-0.11 ng/mL²), allowing differentiation at a threshold of >0.15 ng/mL².</p><p><strong>Conclusion: </strong>In asymptomatic men, PV changed non-linearly with age. Age-related PSA thresholds are supported; however, a static PSA-D threshold of 0.15 ng/mL² can be applied across all age ranges.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"805-812"},"PeriodicalIF":4.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}