Pub Date : 2025-12-17DOI: 10.1016/j.clgc.2025.102486
Nadine A. Friedrich , Michael Luu , Rebecca Gale , Antwon Chaplin , Reva Polineni , Alex Shiang , Dong Shin , Stephen J. Freedland , Brennan Spiegel , Leslie K. Ballas , Paul Kokorowski , Timothy J. Daskivich
Background
Treatment choice for early-stage prostate cancer (PC) is strongly influenced by the counseling physician's specialty. Whether a physician’s specialty biases how treatment advantages and disadvantages are presented in consultations is unclear. To investigate this, we analyzed content discussed by urologists and radiation oncologists when comparing radical prostatectomy and radiation therapy in PC consultations.
Methods
Consultations of 39 men with nonmetastatic PC across 6 urologists and radiation oncologists were recorded and transcribed. Analysts thematically characterized statements comparing advantages and disadvantages of surgery versus radiation (and vice versa) using an open coding approach. Frequency of thematic content by specialty was reported at a consultation level. Themes exceeding 10% and differing by ≥ 25% between specialties were reported.
Results
Our dataset included 1171 statements from 28 Urology and 11 Radiation Oncology consults. Major themes discussed included side effects (90%), cancer control (84%), convenience (56%), salvage options (48%) and invasiveness (43%). Differences in content between specialties were observed for all themes except convenience. For side effects, radiation oncologists (vs. urologists) more often noted that radiation has better urinary (55% vs. 0%) and erectile side effects than surgery (37% vs. 0%). For salvage therapy, urologists more often mentioned inability to get radiation twice (32% vs. 0%) and difficulties with salvage prostatectomy (36% vs. 0%). For cancer control, urologists more often noted long-term data on surgery outcomes as an advantage of surgery (25% vs. 0%). For invasiveness, radiation oncologists more often described radiation as less invasive (36% vs. 11%).
Conclusions
While specialists acknowledge obvious limitations of their treatments, they selectively highlight advantages of their procedures and the disadvantages of competing treatments.
{"title":"Are Urologists and/or Radiation Oncologists Biased when Reporting of Advantages and Disadvantages of Surgery versus Radiation in Consultations for Early-Stage Prostate Cancer?","authors":"Nadine A. Friedrich , Michael Luu , Rebecca Gale , Antwon Chaplin , Reva Polineni , Alex Shiang , Dong Shin , Stephen J. Freedland , Brennan Spiegel , Leslie K. Ballas , Paul Kokorowski , Timothy J. Daskivich","doi":"10.1016/j.clgc.2025.102486","DOIUrl":"10.1016/j.clgc.2025.102486","url":null,"abstract":"<div><h3>Background</h3><div>Treatment choice for early-stage prostate cancer (PC) is strongly influenced by the counseling physician's specialty. Whether a physician’s specialty biases how treatment advantages and disadvantages are presented in consultations is unclear. To investigate this, we analyzed content discussed by urologists and radiation oncologists when comparing radical prostatectomy and radiation therapy in PC consultations.</div></div><div><h3>Methods</h3><div>Consultations of 39 men with nonmetastatic PC across 6 urologists and radiation oncologists were recorded and transcribed. Analysts thematically characterized statements comparing advantages and disadvantages of surgery versus radiation (and vice versa) using an open coding approach. Frequency of thematic content by specialty was reported at a consultation level. Themes exceeding 10% and differing by ≥ 25% between specialties were reported.</div></div><div><h3>Results</h3><div>Our dataset included 1171 statements from 28 Urology and 11 Radiation Oncology consults. Major themes discussed included side effects (90%), cancer control (84%), convenience (56%), salvage options (48%) and invasiveness (43%). Differences in content between specialties were observed for all themes except convenience. For side effects, radiation oncologists (vs. urologists) more often noted that radiation has better urinary (55% vs. 0%) and erectile side effects than surgery (37% vs. 0%). For salvage therapy, urologists more often mentioned inability to get radiation twice (32% vs. 0%) and difficulties with salvage prostatectomy (36% vs. 0%). For cancer control, urologists more often noted long-term data on surgery outcomes as an advantage of surgery (25% vs. 0%). For invasiveness, radiation oncologists more often described radiation as less invasive (36% vs. 11%).</div></div><div><h3>Conclusions</h3><div>While specialists acknowledge obvious limitations of their treatments, they selectively highlight advantages of their procedures and the disadvantages of competing treatments.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 2","pages":"Article 102486"},"PeriodicalIF":2.7,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015855","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}
Pub Date : 2025-12-12DOI: 10.1016/j.clgc.2025.102480
Anne Holck Storås , Kaitlyn M Tsuruda , Tor Åge Myklebust , Erik S Haug , Sophie D Fosså , Bettina Kulle Andreassen
Objective
To evaluate real-world postoperative treatment patterns and survival outcomes among men with nonmetastatic locally advanced prostate cancer (laPCa) undergoing radical prostatectomy (RP) to improve the shared decision-making process.
Material and Methods
All 3022 patients diagnosed with laPCa prostate cancer and registered in Cancer registry of Norway (CRN) who underwent RP within 1 year after diagnosis during 2008-21 were included. Data on disease characteristic’s and radiotherapy were derived from the CRN and data on endocrine treatment and additional systemic therapy (docetaxel, abiraterone, enzalutamide) were provided from the Norwegian Prescription Database and the Norwegian Patient Registry. Cause-specific mortality was estimated using a competing risk framework. Overall survival was calculated as 1 minus the all-cause mortality. The cumulative probability of starting postoperative treatment for relapse was also calculated.
Results
Median follow-up was 4.8 years. Within 10 years post-RP, 34% received postoperative radiotherapy, 19% received endocrine therapy as first treatment, and 14% received additional systemic therapy. Higher PSA, cT3b stage, and ISUP grade 4 to 5 were associated with increased likelihood of postoperative treatment. The 10-year overall mortality was 16%, with most deaths from non-prostate cancer causes. Patients receiving postoperative radiotherapy had low 10-year prostate cancer-specific mortality (2%), whereas those starting endocrine therapy first experienced higher prostate cancer mortality (31%). Among patients progressing to systemic therapy, 5-year mortality was 65%, predominantly due to prostate cancer.
Conclusion
In this large, unselected national cohort, laPCa patients treated with RP had generally favorable long-term survival, but more than half required relapse-directed therapy within 10 years. Relapse risk was strongly linked to baseline tumor characteristics and persisted throughout follow-up, underscoring the need for prolonged surveillance. Future studies should address long-term functional outcomes and quality-of-life after multimodal postoperative treatment.
目的：评估接受根治性前列腺切除术（RP）的非转移性局部晚期前列腺癌（laPCa）患者的术后治疗模式和生存结果，以改善共同决策过程。材料和方法：所有在挪威癌症登记处（cancer registry of Norway， CRN）登记的诊断为laPCa前列腺癌并在诊断后1年内接受RP的3022例患者在2008-21年间被纳入研究。关于疾病特征和放疗的数据来自CRN，关于内分泌治疗和其他全身治疗（多西他赛、阿比特龙、恩杂鲁胺）的数据来自挪威处方数据库和挪威患者登记处。使用竞争风险框架估计病因特异性死亡率。总生存期计算为1减去全因死亡率。计算术后开始治疗复发的累积概率。结果：中位随访时间为4.8年。rp术后10年内，34%接受术后放疗，19%首次接受内分泌治疗，14%接受额外的全身治疗。较高的PSA、cT3b分期和ISUP 4 - 5级与术后治疗的可能性增加相关。10年的总死亡率为16%，其中大多数死于非前列腺癌。接受术后放疗的患者10年前列腺癌特异性死亡率较低（2%），而首先开始内分泌治疗的患者前列腺癌死亡率较高（31%）。在进行全身治疗的患者中，5年死亡率为65%，主要是由于前列腺癌。结论：在这个庞大的，未选择的国家队列中，接受RP治疗的laPCa患者通常具有良好的长期生存，但超过一半的患者需要在10年内接受复发定向治疗。复发风险与基线肿瘤特征密切相关，并在随访期间持续存在，强调了长期监测的必要性。未来的研究应该关注多模式术后治疗后的长期功能结果和生活质量。
{"title":"Postoperative Treatment and Survival in Locally Advanced Prostate Cancer: Real-World Outcomes","authors":"Anne Holck Storås , Kaitlyn M Tsuruda , Tor Åge Myklebust , Erik S Haug , Sophie D Fosså , Bettina Kulle Andreassen","doi":"10.1016/j.clgc.2025.102480","DOIUrl":"10.1016/j.clgc.2025.102480","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate real-world postoperative treatment patterns and survival outcomes among men with nonmetastatic locally advanced prostate cancer (laPCa) undergoing radical prostatectomy (RP) to improve the shared decision-making process.</div></div><div><h3>Material and Methods</h3><div>All 3022 patients diagnosed with laPCa prostate cancer and registered in Cancer registry of Norway (CRN) who underwent RP within 1 year after diagnosis during 2008-21 were included. Data on disease characteristic’s and radiotherapy were derived from the CRN and data on endocrine treatment and additional systemic therapy (docetaxel, abiraterone, enzalutamide) were provided from the Norwegian Prescription Database and the Norwegian Patient Registry. Cause-specific mortality was estimated using a competing risk framework. Overall survival was calculated as 1 minus the all-cause mortality. The cumulative probability of starting postoperative treatment for relapse was also calculated.</div></div><div><h3>Results</h3><div>Median follow-up was 4.8 years. Within 10 years post-RP, 34% received postoperative radiotherapy, 19% received endocrine therapy as first treatment, and 14% received additional systemic therapy. Higher PSA, cT3b stage, and ISUP grade 4 to 5 were associated with increased likelihood of postoperative treatment. The 10-year overall mortality was 16%, with most deaths from non-prostate cancer causes. Patients receiving postoperative radiotherapy had low 10-year prostate cancer-specific mortality (2%), whereas those starting endocrine therapy first experienced higher prostate cancer mortality (31%). Among patients progressing to systemic therapy, 5-year mortality was 65%, predominantly due to prostate cancer.</div></div><div><h3>Conclusion</h3><div>In this large, unselected national cohort, laPCa patients treated with RP had generally favorable long-term survival, but more than half required relapse-directed therapy within 10 years. Relapse risk was strongly linked to baseline tumor characteristics and persisted throughout follow-up, underscoring the need for prolonged surveillance. Future studies should address long-term functional outcomes and quality-of-life after multimodal postoperative treatment.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102480"},"PeriodicalIF":2.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949523","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}
Pub Date : 2025-12-11DOI: 10.1016/j.clgc.2025.102484
Audreylie Lemelin , Martin Zarba , Kosuke Takemura , J. Connor Wells , Razane El Hajj Chehade , Frede Donskov , Camillo Porta , Guillermo De Velasco , Ian D. Davis , Lori A. Wood , Sumanta K. Pal , Aaron R. Hansen , Ben Tran , Georg A. Bjarnason , Haoran Li , Ravindran Kanesvaran , Thomas Powles , Rana R. McKay , Toni K. Choueiri , Daniel Y.C. Heng
Background
Attrition rates for patients with mRCC are not well characterized in the era of immunoncology (IO)-based combinations. This study aims to quantify real-world attrition rates by line of therapy, analyze associated clinical predictors, and describe treatment sequencing across multiple international centers.
Methods
IMDC data for patients with mRCC who received first line Nivolumab + Ipilimumab (IO-IO) or IO- Vascular Endothelial Growth Factor receptor targeted therapy (VEGFR TT) (IO-VE) were included. Clinical and pathologic characteristics and outcomes were extracted. Chi-square tests were used to compare categorical variables between patients who received second line and those who did not. A logistic regression model was used to assess predictors of second line therapy initiation.
Results
A total of 1411 patients were identified, of whom 995 patients were treated with first line IO-IO and 434 with IO-VE. Of them, 935 (704 first line IO-IO and 231 first line IO-VE) stopped first line and were suitable for second line therapy. Reasons for stopping first line included progressive disease (PD) in 41.1%, toxicity in 24.4%, death in 3.9%, complete response in 1.5% and other in 28.3%. Among second line suitable patients, 544 (58.2%) started any second line whereas 391 (41.8%) did not. Patients who stopped first line for PD were more likely to initiate second line than those who stopped for other reasons (57.9% vs. 17.6%, P < .00001). Patients who received second line were more likely to have clear-cell histology (77.2% vs. 66.8%, P = .04), without sarcomatoid features (57.2 vs. 44.8%, P = .02), a Karnofsky performance score (KPS) of 80 or higher (80.1 vs. 73.9%, P = .01), and bone metastases (39.0 vs. 28.1%, P = .0009). (Table 2). After adjusting for IMDC criteria, only age and reason for stopping first line remained significant predictors of receiving second line therapy. Among 353 patients who stopped second line, 199 (56.4%, overall 21.3%) started third line therapy. Of the 139 patients who stopped third line, 80 (57.6%, overall 8.6%) started fourth line therapy.
Conclusions
In this real-world analysis, we found that just over half of suitable patients received the subsequent line of therapy post first line. We were able to identify age and reason for stopping first line as predictors of second line therapy initiation.
{"title":"Attrition Rates in Metastatic Renal Cell Carcinoma (mRCC) Following First Line Immunotherapy-Based Treatment: Results From the International mRCC Database Consortium (IMDC)","authors":"Audreylie Lemelin , Martin Zarba , Kosuke Takemura , J. Connor Wells , Razane El Hajj Chehade , Frede Donskov , Camillo Porta , Guillermo De Velasco , Ian D. Davis , Lori A. Wood , Sumanta K. Pal , Aaron R. Hansen , Ben Tran , Georg A. Bjarnason , Haoran Li , Ravindran Kanesvaran , Thomas Powles , Rana R. McKay , Toni K. Choueiri , Daniel Y.C. Heng","doi":"10.1016/j.clgc.2025.102484","DOIUrl":"10.1016/j.clgc.2025.102484","url":null,"abstract":"<div><h3>Background</h3><div>Attrition rates for patients with mRCC are not well characterized in the era of immunoncology (IO)-based combinations. This study aims to quantify real-world attrition rates by line of therapy, analyze associated clinical predictors, and describe treatment sequencing across multiple international centers.</div></div><div><h3>Methods</h3><div>IMDC data for patients with mRCC who received first line Nivolumab + Ipilimumab (IO-IO) or IO- Vascular Endothelial Growth Factor receptor targeted therapy (VEGFR TT) (IO-VE) were included. Clinical and pathologic characteristics and outcomes were extracted. Chi-square tests were used to compare categorical variables between patients who received second line and those who did not. A logistic regression model was used to assess predictors of second line therapy initiation.</div></div><div><h3>Results</h3><div>A total of 1411 patients were identified, of whom 995 patients were treated with first line IO-IO and 434 with IO-VE. Of them, 935 (704 first line IO-IO and 231 first line IO-VE) stopped first line and were suitable for second line therapy. Reasons for stopping first line included progressive disease (PD) in 41.1%, toxicity in 24.4%, death in 3.9%, complete response in 1.5% and other in 28.3%. Among second line suitable patients, 544 (58.2%) started any second line whereas 391 (41.8%) did not. Patients who stopped first line for PD were more likely to initiate second line than those who stopped for other reasons (57.9% vs. 17.6%, <em>P</em> < .00001). Patients who received second line were more likely to have clear-cell histology (77.2% vs. 66.8%, <em>P</em> = .04), without sarcomatoid features (57.2 vs. 44.8%, <em>P</em> = .02), a Karnofsky performance score (KPS) of 80 or higher (80.1 vs. 73.9%, <em>P</em> = .01), and bone metastases (39.0 vs. 28.1%, <em>P</em> = .0009). (Table 2). After adjusting for IMDC criteria, only age and reason for stopping first line remained significant predictors of receiving second line therapy. Among 353 patients who stopped second line, 199 (56.4%, overall 21.3%) started third line therapy. Of the 139 patients who stopped third line, 80 (57.6%, overall 8.6%) started fourth line therapy.</div></div><div><h3>Conclusions</h3><div>In this real-world analysis, we found that just over half of suitable patients received the subsequent line of therapy post first line. We were able to identify age and reason for stopping first line as predictors of second line therapy initiation.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102484"},"PeriodicalIF":2.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921101","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}
Pub Date : 2025-12-11DOI: 10.1016/j.clgc.2025.102482
İhsan Solmaz , Halil Kömek , Fethullah Kayan , Canan Can , İhsan Kaplan , Rıdvan Kiliç , Yunus Güzel , Mehmet Serdar Yildirim , Ömer Faruk Alakuş , Bilgin Bahadır Başgöz , Mehmet Özel , Eşref Araç
Objective
To investigate the association between fat and muscle mass parameters and overall survival in patients with castration-resistant metastatic prostate cancer (mCRPC) receiving chemotherapy or androgen deprivation therapy.
Materials and Methods
This retrospective study included mCRPC patients treated with docetaxel, abiraterone, or enzalutamide between January 01, 2017 and December 31, 2022. CT images at the L3 vertebral level were used to measure the cross-sectional areas of psoas muscle (PM), skeletal muscle (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). These values were normalized by height (cm²/m²) to calculate indices (PMI, SMI, VATI, SATI). Mean hounsfield unit (HU) values of right and left PM were used to assess myosteatosis. Changes in body composition before and after treatment (eg, ΔVATI, ΔSATI) were also calculated. Survival analysis was performed using (ROC) receiver operating curves and Kaplan-Meier tests.
Results
Univariate Cox regression showed significant associations between mortality and age, treatment type, right PM HU (pre and post-treatment), left PM HU (post-treatment), post-treatment VATI, ΔSATI, ΔVATI, and baseline PMI (P < .05 for all). In multivariate analysis, post-treatment right PM HU and VATI were independent prognostic factors (P = .02 and P < .001, respectively).
Conclusion
Fat mass, sarcopenia, and myosteatosis—especially post-treatment VATI and right PM attenuation—were associated with survival in mCRPC. Fat loss and increased myosteatosis may negatively affect prognosis, highlighting the importance of body composition monitoring during treatment.
{"title":"Association of Fat and Muscle Mass With Overall Survival in Patients With Metastatic Prostate Cancer Treated With Enzalutamide, Abiraterone, and Docetaxel","authors":"İhsan Solmaz , Halil Kömek , Fethullah Kayan , Canan Can , İhsan Kaplan , Rıdvan Kiliç , Yunus Güzel , Mehmet Serdar Yildirim , Ömer Faruk Alakuş , Bilgin Bahadır Başgöz , Mehmet Özel , Eşref Araç","doi":"10.1016/j.clgc.2025.102482","DOIUrl":"10.1016/j.clgc.2025.102482","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between fat and muscle mass parameters and overall survival in patients with castration-resistant metastatic prostate cancer (mCRPC) receiving chemotherapy or androgen deprivation therapy.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study included mCRPC patients treated with docetaxel, abiraterone, or enzalutamide between January 01, 2017 and December 31, 2022. CT images at the L3 vertebral level were used to measure the cross-sectional areas of psoas muscle (PM), skeletal muscle (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). These values were normalized by height (cm²/m²) to calculate indices (PMI, SMI, VATI, SATI). Mean hounsfield unit (HU) values of right and left PM were used to assess myosteatosis. Changes in body composition before and after treatment (eg, ΔVATI, ΔSATI) were also calculated. Survival analysis was performed using (ROC) receiver operating curves and Kaplan-Meier tests.</div></div><div><h3>Results</h3><div>Univariate Cox regression showed significant associations between mortality and age, treatment type, right PM HU (pre and post-treatment), left PM HU (post-treatment), post-treatment VATI, ΔSATI, ΔVATI, and baseline PMI (<em>P</em> < .05 for all). In multivariate analysis, post-treatment right PM HU and VATI were independent prognostic factors (<em>P</em> = .02 and <em>P</em> < .001, respectively).</div></div><div><h3>Conclusion</h3><div>Fat mass, sarcopenia, and myosteatosis—especially post-treatment VATI and right PM attenuation—were associated with survival in mCRPC. Fat loss and increased myosteatosis may negatively affect prognosis, highlighting the importance of body composition monitoring during treatment.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102482"},"PeriodicalIF":2.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921103","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}
Pub Date : 2025-12-11DOI: 10.1016/j.clgc.2025.102483
Abby L. Grier , Albert Jang , Jeffrey Y. Zhong , Hamsa L.S. Kumar , Tanya Jindal , Adam Calaway , Angela Y. Jia , Pingfu Fu , Laura Bukavina , Rashed Ghandour , Jonathan E. Shoag , Randy Vince , Santosh Rao , Iris Sheng , Prateek Mendiratta , Jason R. Brown , Shilpa Gupta , Jorge A. Garcia , Pedro C. Barata
Introduction
Immune checkpoint inhibitors are a standard of care in managing locally advanced and metastatic genitourinary cancers.
Methods
We evaluated the utilization of immune checkpoint inhibitors as subsequent therapy in patients enrolled to 11 registrational phase III cancer immunotherapy trials that demonstrated an overall survival benefit.
Results
For renal cell carcinoma (n = 5135 patients, 2014-2019), approximately 60% of control-arm patients received subsequent therapy upon progression, with 70% of those receiving an immune checkpoint inhibitor. For urothelial carcinoma (n = 3445 patients, 2015-2022), 54% of control-arm patients received subsequent therapy upon progression, with 69% of those receiving an immune checkpoint inhibitor.
Conclusion
Patients randomized to the control arm of these trials did not consistently receive immune checkpoint inhibitors upon progression. Further research is needed to understand how access to subsequent therapies impacts overall survival, and to identify factors associated with inconsistent provision of subsequent therapies.
{"title":"Non-Immunotherapy Arm Allocations in Phase 3 Genitourinary Cancer Trials with Immunotherapy","authors":"Abby L. Grier , Albert Jang , Jeffrey Y. Zhong , Hamsa L.S. Kumar , Tanya Jindal , Adam Calaway , Angela Y. Jia , Pingfu Fu , Laura Bukavina , Rashed Ghandour , Jonathan E. Shoag , Randy Vince , Santosh Rao , Iris Sheng , Prateek Mendiratta , Jason R. Brown , Shilpa Gupta , Jorge A. Garcia , Pedro C. Barata","doi":"10.1016/j.clgc.2025.102483","DOIUrl":"10.1016/j.clgc.2025.102483","url":null,"abstract":"<div><h3>Introduction</h3><div>Immune checkpoint inhibitors are a standard of care in managing locally advanced and metastatic genitourinary cancers.</div></div><div><h3>Methods</h3><div>We evaluated the utilization of immune checkpoint inhibitors as subsequent therapy in patients enrolled to 11 registrational phase III cancer immunotherapy trials that demonstrated an overall survival benefit.</div></div><div><h3>Results</h3><div>For renal cell carcinoma (<em>n</em> = 5135 patients, 2014-2019), approximately 60% of control-arm patients received subsequent therapy upon progression, with 70% of those receiving an immune checkpoint inhibitor. For urothelial carcinoma (<em>n</em> = 3445 patients, 2015-2022), 54% of control-arm patients received subsequent therapy upon progression, with 69% of those receiving an immune checkpoint inhibitor.</div></div><div><h3>Conclusion</h3><div>Patients randomized to the control arm of these trials did not consistently receive immune checkpoint inhibitors upon progression. Further research is needed to understand how access to subsequent therapies impacts overall survival, and to identify factors associated with inconsistent provision of subsequent therapies.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102483"},"PeriodicalIF":2.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967993","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}
Pub Date : 2025-12-09DOI: 10.1016/j.clgc.2025.102481
Dejan K. Filipas , José I. Nolazco , Benjamin V. Stone , Michael Rink , Edoardo Beatrici , Muhieddine Labban , Stuart R. Lipsitz , Margit Fisch , Toni K. Choueiri , Alexander P. Cole , Quoc-Dien Trinh , Steve L. Chang
Background and Objective
Indeterminate pathological margins (Rx) in renal cell carcinoma (RCC) surgery may affect overall survival. This study aims to evaluate Rx rates, identify predictive factors, and assess their impact on overall survival compared to negative margins (R0).
Methods
We conducted a retrospective analysis of 473,152 RCC patients from the National Cancer Database (2004-2020). Patients underwent partial or radical nephrectomy. The primary outcome was Rx at final pathology. Multivariable logistic regression and Cox proportional hazard regression were employed to identify predictors and assess survival impact.
Key Findings and Limitations
Rx was observed in 0.62% of cases. Partial nephrectomy, laparoscopic approach, and major vein involvement were associated with increased odds of Rx. Rx was linked to worse overall survival (adjusted Hazard Ratio 1.38; 95% CI, 1.22-1.57; P < .01). Limitations include selection bias and data quality variations.
Conclusions and Clinical Implications
Our study indicates that Rx should not be considered equivalent to R0 resection status, as it is associated with worse overall survival in RCC. These findings may aid in the postoperative risk assessment of RCC patients and guide clinical decision-making.
背景和目的：肾细胞癌（RCC）手术中不确定的病理边缘（Rx）可能影响总生存期。本研究旨在评估Rx率，确定预测因素，并评估其与负边缘（R0）相比对总生存率的影响。方法：我们对来自国家癌症数据库（2004-2020）的473,152例RCC患者进行了回顾性分析。患者接受部分或根治性肾切除术。主要结果为最终病理时的Rx。采用多变量logistic回归和Cox比例风险回归来确定预测因素并评估生存影响。主要发现和局限性：0.62%的病例使用Rx。部分肾切除术、腹腔镜入路和主要静脉受累与Rx的发生率增加有关。Rx与较差的总生存率相关（校正风险比1.38;95% CI, 1.22-1.57; P < 0.01）。局限性包括选择偏差和数据质量变化。结论和临床意义：我们的研究表明，Rx不应等同于R0切除状态，因为Rx与RCC的总生存期较差相关。这些发现可能有助于RCC患者的术后风险评估和指导临床决策。
{"title":"Indeterminate Surgical Margins (Rx) in Renal Cell Carcinoma Surgery: Rates, Predictive Factors, and Impact on Overall Survival","authors":"Dejan K. Filipas , José I. Nolazco , Benjamin V. Stone , Michael Rink , Edoardo Beatrici , Muhieddine Labban , Stuart R. Lipsitz , Margit Fisch , Toni K. Choueiri , Alexander P. Cole , Quoc-Dien Trinh , Steve L. Chang","doi":"10.1016/j.clgc.2025.102481","DOIUrl":"10.1016/j.clgc.2025.102481","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Indeterminate pathological margins (Rx) in renal cell carcinoma (RCC) surgery may affect overall survival. This study aims to evaluate Rx rates, identify predictive factors, and assess their impact on overall survival compared to negative margins (R0).</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 473,152 RCC patients from the National Cancer Database (2004-2020). Patients underwent partial or radical nephrectomy. The primary outcome was Rx at final pathology. Multivariable logistic regression and Cox proportional hazard regression were employed to identify predictors and assess survival impact.</div></div><div><h3>Key Findings and Limitations</h3><div>Rx was observed in 0.62% of cases. Partial nephrectomy, laparoscopic approach, and major vein involvement were associated with increased odds of Rx. Rx was linked to worse overall survival (adjusted Hazard Ratio 1.38; 95% CI, 1.22-1.57; <em>P</em> < .01). Limitations include selection bias and data quality variations.</div></div><div><h3>Conclusions and Clinical Implications</h3><div>Our study indicates that Rx should not be considered equivalent to R0 resection status, as it is associated with worse overall survival in RCC. These findings may aid in the postoperative risk assessment of RCC patients and guide clinical decision-making.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102481"},"PeriodicalIF":2.7,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949502","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}
Pub Date : 2025-11-29DOI: 10.1016/j.clgc.2025.102478
Gabriele Ricciardi , Pietro Tralongo , Francesco Pierconti , Valeria Zuccalà , Vincenzo Fiorentino , Ludovica Pepe , Mariagiovanna Ballato , Antonio Ieni , Marta Rossanese , Vincenzo Ficarra , Guido Fadda , Maurizio Martini
Carcinoma in situ (CIS) of the urinary tract is an aggressive, flat, high-grade form of non–muscle-invasive urothelial carcinoma, associated with a high risk of recurrence and progression. Its diagnosis remains challenging due to the absence of specific symptoms and the frequent overlap with benign inflammatory lesions. Although intravesical Bacillus Calmette-Guérin (BCG) remains the standard of care, many patients experience relapse or develop BCG-unresponsive disease, for which effective alternatives are urgently needed. Recent advances in diagnostic techniques, such as narrow band imaging and photodynamic diagnosis, have improved detection accuracy, while novel therapeutic strategies, such as immune checkpoint inhibitors, thermo-chemotherapy, intravescical gene therapy (nadofaragene firadenovec), IL-15 superagonists (eg, ALT-803), and oncolytic viral therapies (eg, CG0070), are expanding the treatment landscape. Furthermore, emerging molecular and immune-related biomarkers may help predict response to therapy and guide personalized management. This review summarizes current evidence on the biology, diagnosis, and treatment of CIS, highlighting key challenges and future directions in the effort to improve patient outcomes and reduce the need for radical cystectomy.
{"title":"Urothelial Carcinoma In Situ: Advances in Diagnosis and Management","authors":"Gabriele Ricciardi , Pietro Tralongo , Francesco Pierconti , Valeria Zuccalà , Vincenzo Fiorentino , Ludovica Pepe , Mariagiovanna Ballato , Antonio Ieni , Marta Rossanese , Vincenzo Ficarra , Guido Fadda , Maurizio Martini","doi":"10.1016/j.clgc.2025.102478","DOIUrl":"10.1016/j.clgc.2025.102478","url":null,"abstract":"<div><div>Carcinoma in situ (CIS) of the urinary tract is an aggressive, flat, high-grade form of non–muscle-invasive urothelial carcinoma, associated with a high risk of recurrence and progression. Its diagnosis remains challenging due to the absence of specific symptoms and the frequent overlap with benign inflammatory lesions. Although intravesical <em>Bacillus</em> Calmette-Guérin (BCG) remains the standard of care, many patients experience relapse or develop BCG-unresponsive disease, for which effective alternatives are urgently needed. Recent advances in diagnostic techniques, such as narrow band imaging and photodynamic diagnosis, have improved detection accuracy, while novel therapeutic strategies, such as immune checkpoint inhibitors, thermo-chemotherapy, intravescical gene therapy (nadofaragene firadenovec), IL-15 superagonists (eg, ALT-803), and oncolytic viral therapies (eg, CG0070), are expanding the treatment landscape. Furthermore, emerging molecular and immune-related biomarkers may help predict response to therapy and guide personalized management. This review summarizes current evidence on the biology, diagnosis, and treatment of CIS, highlighting key challenges and future directions in the effort to improve patient outcomes and reduce the need for radical cystectomy.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102478"},"PeriodicalIF":2.7,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806789","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}
Pub Date : 2025-11-25DOI: 10.1016/j.clgc.2025.102476
Wadih Issa , Maureen Aliru , Song Zhang , Damla Gunenc , Changchuan Jiang , Qian Qin , Suzanne Cole , Waddah Arafat , Jue Wang , Daniel Yang , Neil Desai , Aurelie Garant , Raquibul Hannan , Orhan K. Oz , Solomon Woldu , Yair Lotan , Claus Roehrborn , Kevin Courtney , Andrew Z. Wang , Tian Zhang
Background
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging is highly sensitive, enabling detection of disease not visualized on conventional imaging, and leading to a new disease state: PSMA-avid/CT-negative metastatic prostate cancer. The optimal management and treatment outcomes for this group remain poorly defined. We investigated whether treatment intensification with androgen receptor signaling inhibitors (ARSI) provides additional benefit for these patients.
Methods
We conducted a retrospective study of patients with metastatic hormone-sensitive prostate cancer (mHSPC) diagnosed via standard-of-care PSMA PET/CT imaging (Ga68 gozetotide/PSMA-11) at our institution. Patients were stratified based on whether PSMA-avid lesions (SUVmax > 2.5) had correlates on conventional imaging: PSMA (+)/CT (−) versus PSMA (+)/CT (+). We compared prostate-specific antigen progression-free survival (PSA PFS) and castration resistance-free survival (CRFS) between cohorts. OS was not assessed.
Results
Among 159 patients, 81 (51%) had PSMA (+)/CT (−) and 78 (49%) had PSMA (+)/CT (+) disease. With a median follow up of 23 months, patients with PSMA (+)/CT (−) mHSPC had significantly longer PSA PFS (hazard ratio [HR] 0.31, P = .01) and CRFS (HR 0.08, P < .001). Within the PSMA (+)/CT (−) cohort, ARSI intensification did not improve CRFS compared to androgen deprivation therapy (ADT) monotherapy (HR 0.32, P = .33).
Conclusions
Patients with PSMA (+)/CT (−) mHSPC exhibit a more favorable prognosis with reduced risk of PSA progression and castration resistance compared to those with PSMA (+)/CT (+) disease. However, among patients treated with ADT alone, CRFS was similar across groups, suggesting that the benefit of ARSI intensification in PSMA (+)/CT (−) patients requires prospective validation.
前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）成像是高度敏感的，能够检测到传统成像无法显示的疾病，并导致一种新的疾病状态：PSMA-avid/ ct阴性转移性前列腺癌。该组的最佳管理和治疗结果仍不明确。我们研究了雄激素受体信号抑制剂（ARSI）的强化治疗是否为这些患者提供了额外的益处。方法：我们对我院通过标准护理PSMA PET/CT成像（Ga68 gozetotide/PSMA-11）诊断的转移性激素敏感性前列腺癌（mHSPC）患者进行了回顾性研究。根据PSMA-avid病变（SUVmax > 2.5）是否与常规影像学相关，对患者进行分层：PSMA (+)/CT (-) vs PSMA (+)/CT（+）。我们比较了队列间前列腺特异性抗原无进展生存期（PSA PFS）和去势抵抗无生存期（CRFS）。未评估OS。结果159例患者中，81例（51%）为PSMA (+)/CT（−）病变，78例（49%）为PSMA (+)/CT（+）病变。中位随访时间为23个月，PSMA (+)/CT(−)mHSPC患者的PSA PFS（风险比[HR] 0.31, P = 0.01）和CRFS（风险比[HR] 0.08, P < 001）均显著延长。在PSMA (+)/CT（−）队列中，与雄激素剥夺治疗（ADT）单药治疗相比，ARSI强化并没有改善CRFS （HR 0.32, P = 0.33）。结论与PSMA (+)/CT (+) mHSPC患者相比，PSMA (+)/CT (+) mHSPC患者预后更好，PSA进展和去势抵抗风险降低。然而，在单独接受ADT治疗的患者中，各组间的CRFS相似，这表明在PSMA (+)/CT（-）患者中ARSI强化的益处需要前瞻性验证。
{"title":"Real-World Treatment Outcomes in Patients With Ga68-PSMA-PET Positive Metastatic Hormone-Sensitive Prostate Cancer With or Without Conventional Imaging Correlates","authors":"Wadih Issa , Maureen Aliru , Song Zhang , Damla Gunenc , Changchuan Jiang , Qian Qin , Suzanne Cole , Waddah Arafat , Jue Wang , Daniel Yang , Neil Desai , Aurelie Garant , Raquibul Hannan , Orhan K. Oz , Solomon Woldu , Yair Lotan , Claus Roehrborn , Kevin Courtney , Andrew Z. Wang , Tian Zhang","doi":"10.1016/j.clgc.2025.102476","DOIUrl":"10.1016/j.clgc.2025.102476","url":null,"abstract":"<div><h3>Background</h3><div>Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging is highly sensitive, enabling detection of disease not visualized on conventional imaging, and leading to a new disease state: PSMA-avid/CT-negative metastatic prostate cancer. The optimal management and treatment outcomes for this group remain poorly defined. We investigated whether treatment intensification with androgen receptor signaling inhibitors (ARSI) provides additional benefit for these patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of patients with metastatic hormone-sensitive prostate cancer (mHSPC) diagnosed via standard-of-care PSMA PET/CT imaging (Ga68 gozetotide/PSMA-11) at our institution. Patients were stratified based on whether PSMA-avid lesions (SUVmax > 2.5) had correlates on conventional imaging: PSMA (+)/CT (−) versus PSMA (+)/CT (+). We compared prostate-specific antigen progression-free survival (PSA PFS) and castration resistance-free survival (CRFS) between cohorts. OS was not assessed.</div></div><div><h3>Results</h3><div>Among 159 patients, 81 (51%) had PSMA (+)/CT (−) and 78 (49%) had PSMA (+)/CT (+) disease. With a median follow up of 23 months, patients with PSMA (+)/CT (−) mHSPC had significantly longer PSA PFS (hazard ratio [HR] 0.31, <em>P</em> = .01) and CRFS (HR 0.08, <em>P</em> < .001). Within the PSMA (+)/CT (−) cohort, ARSI intensification did not improve CRFS compared to androgen deprivation therapy (ADT) monotherapy (HR 0.32, <em>P</em> = .33).</div></div><div><h3>Conclusions</h3><div>Patients with PSMA (+)/CT (−) mHSPC exhibit a more favorable prognosis with reduced risk of PSA progression and castration resistance compared to those with PSMA (+)/CT (+) disease. However, among patients treated with ADT alone, CRFS was similar across groups, suggesting that the benefit of ARSI intensification in PSMA (+)/CT (−) patients requires prospective validation.</div></div>","PeriodicalId":10380,"journal":{"name":"Clinical genitourinary cancer","volume":"24 1","pages":"Article 102476"},"PeriodicalIF":2.7,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145836486","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}
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