Current Opinion in Urology最新文献

Purpose of review: This review provides a comprehensive and updated overview of current concepts, technical advances, and future directions regarding sarcomatoid urothelial carcinoma, an aggressive subtype of urothelial carcinoma that affects the urinary bladder and upper tract.

Recent findings: This review examines recent advances in pathology, molecular profiles, and molecular therapeutic targets in sarcomatoid urothelial carcinoma with emphasis on their clinical impact in practice. Recent data on chemotherapy and surgical approaches to these aggressive tumors are also discussed. Of relevance is the identification of sarcomatoid urothelial carcinoma as a basal molecular subtype, characterized by frequent expression of PD-1/PD-L1 and a potential response to immune checkpoint inhibitors. The status of other potential targets of novel therapies, such as Nectin-4, TROP2, FGFR3 , and HER2 , is also addressed.

Summary: The implications of new developments in clinical practice range from the corrected differential diagnosis of sarcomatoid urothelial carcinoma from its mimics to the potential value of neoadjuvant chemotherapy followed by radical cystectomy, and the use of immune checkpoint inhibitors in metastatic sarcomatoid urothelial cancer, which improve clinical management and offer survival benefits for these patients. The use of novel therapies targeting molecular pathways represents a significant advance, enabling more precise and individualized treatment strategies.

Purpose of review: Testicular germ cell tumors (TGCTs) are the most common neoplasms in young-adult males. Despite their good prognosis and high curability, some challenges remain, namely: overtreatment, discrimination of teratoma, prediction of relapse and cisplatin resistance. Novel molecular biomarkers are being tested for future clinical implementation.

Recent findings: MicroRNAs (miRNAs) are the most promising approach for noninvasive diagnosis of TGCTs. MiR-371a-3p has shown high sensitivity and specificity in many studies with different approaches and is in line to enter clinical routine soon. Novel immunohistochemistry (IHC) biomarkers like FOXA2 have been advanced for yolk sac tumor diagnosis. Circulating tumor DNA (ctDNA) levels for minimal residual disease (MRD) detection constitutes a promising test in the field.

Summary: Further studies on additional noninvasive biomarkers with high sensitivity are necessary. In this setting, miR-371a-3p remains the most promising biomarker, approaching clinical implementation soon. Other promising approaches are being studied but to date with significantly less accuracy than miR-371a-3p. Future studies on liquid biopsies should focus on the detection of teratoma and prediction of relapse, with the field of miRNAs and ctDNA being the most promising.

Purpose of review: This review outlines a pathology-driven framework that integrates morphology, immunophenotype, and molecular profiling to inform personalized treatment strategies in renal cell carcinoma (RCC), particularly with immunotherapy and tyrosine kinase inhibitors (TKIs).

Recent findings: Systemic therapy for RCC has progressed from cytokine-based regimens to VEGF-targeted TKIs and, more recently, immune checkpoint inhibitors (ICIs), alone or in TKI combinations, resulting in improved survival. Yet, reliable predictive biomarkers remain an unmet need. Programmed death-ligand 1 (PD-L1) expression, while biologically relevant, offers limited clinical utility, as ICI responses occur in both PD-L1-positive and -negative tumors. Tumor microenvironment features (e.g., T-effector and myeloid inflammation signatures) and genomic alterations (e.g., PBRM1 , BAP1 , SETD2 ) provide biological and prognostic insights, but have inconsistent predictive value.

Summary: Pathology remains essential for accurate histologic classification, grading, and assessment of adverse features such as sarcomatoid changes and necrosis. Molecular profiling is increasingly helpful in non-clear cell RCC, guiding targeted therapies in subtypes such as MET-driven papillary RCC. Emerging tools (liquid biopsy, spatial transcriptomics, and AI-assisted pathology) offer minimally invasive monitoring, refined immune profiling, and multiparametric biomarker integration to advance precision oncology in RCC.

Purpose of review: To give an overview of the advances in treatment, diagnosis, and epidemiological data of urachal tumors in 2024 and 2025.

Recent findings: The update specifically refers to surgical approaches for localized cancers, drug therapy of advanced cancers, diagnostic criteria and consensus recommendations, diagnostic approaches, and epidemiological data.

Summary: Recommendations for partial cystectomy (if feasible) in localized urachal adenocarcinomas helps to standardize therapeutic approaches. In addition, current clinical trial results and running studies will help to personalize treatment decisions in advanced disease. The ISUP Dublin consensus recommendations will facilitate the diagnostic process and research, as will the summarized, unbiased epidemiological data.

Purpose of review: Active surveillance is gaining traction in treatment of prostate adenocarcinoma (PCa), The most important step in active surveillance is patient selection. This is a comprehensive review of the current active surveillance strategies and features helpful in proper selection of the patients.

Recent findings: Active surveillance is considered the treatment of choice in low-risk PCa, and new data show its success in management of intermediate-risk PCa.

Summary: Active surveillance is a treatment strategy to offer the PSA patients close monitoring by periodic PSA assessments, Digital rectal examination, imaging studies and needle biopsies. When the patient population is accurately selected, treatment by active surveillance is successful, it also avoids overtreatment and reduces treatment-associated comorbidities. Active surveillance is currently considered the treatment of choice for very low-grade and low-grade PCa and is being offered to some favorable intermediate risk PCa. For active surveillance to be successful, there should be a comprehensive surveillance plan, proper use of the clinical diagnostic tests and continuous patient commitment.

Purpose of review: The biological significance of urothelial carcinoma subtypes/divergent differentiation (S/DD) and clinical approach to them remain challenging issues. This review aims to summarize the most relevant recent information on urothelial carcinoma subtypes/divergent differentiation.

Recent findings: The urothelial carcinoma S/DDs have variable histologies and different genetic alterations. They are considered as high-grade by WHO-2022 system, but they still have prognostic variances and should not be pooled into a single clinicopathological group. Studies confirm that sarcomatoid, micropapillary, plasmacytoid and neuroendocrine forms follow more aggressive course even after other clinicopathological variables are matched. Their higher volume is associated with upstaging and decreased survival. The presence and extent of any S/DD should be documented in all specimens submitted to pathology without a cutoff threshold. Optimal treatment for the aggressive forms is controversial including the use of neoadjuvant chemotherapy. Somatic alterations, some of which are likely oncogenic and targetable, occur in urothelial carcinomas with markedly variable frequency among different subtypes.

Summary: The role of intravesical treatment, neoadjuvant or adjuvant chemotherapy has not been well characterized for most subtypes, and prospective data are inadequate. Understanding detailed molecular biology of these tumors, development of personalized biomarkers and design of clinical trials focusing specifically on S/DDs with worse prognosis are needed to improve patient care.

Purpose of review: Detection of positive surgical margins during radical prostatectomy is critical to minimizing the risk of prostate cancer recurrence. This review deals with established methods, recent advances in real-time intraoperative technologies, and future directions in margin assessment.

Recent findings: This review examines traditional methods, real-time technologies, and prospects in intraoperative margin assessment. It is based on questions put forward by patients and patient advocates (or representatives) and related to achieving negative surgical margins (SMs). The answers are given by uropathologists. This review focuses on intraoperative frozen section (IFS) of surgical margins and fluorescence confocal microscopy (FCM) and, to a less extent, on real-time augmented reality (AR), and intraoperative margin assessment with prostate-specific membrane antigen (PSMA). Innovations in intraoperative imaging and tissue analysis are enhancing the detection of tumor involvement not only at the prostate surface but also within the surrounding periprostatic tissues.

Summary: These technologies, particularly when integrated with artificial intelligence, are poised to transform the surgical management of prostate cancer by enabling more precise and individualized treatment strategies.

Purpose of review: This review provides a comprehensive update on renal angiomyolipoma, a mesenchymal neoplasm within the PEComa family. It revisits its historical classification, evolving pathological understanding, and recent molecular insights, emphasizing its relevance in current diagnostic and pathogenetic contexts.

Recent findings: Angiomyolipoma/PEComa has transitioned from being considered a hamartoma to a neoplasm with clonal origin and malignant potential in a few epithelioid angiomyolipoma/pure epithelioid PEComa. Advances in immunohistochemistry have identified new markers such as GPNMB, STING, and TRIM63, aiding differential diagnosis. Molecular studies highlight frequent TSC1/TSC2 mutations and mTOR pathway dysregulation. Emerging evidence suggests a noncanonical activation of TFEB via the cGAS-STING pathway in angiomyolipoma/PEComa.

Summary: A thorough understanding of the histological subtypes and molecular drivers of angiomyolipoma/PEComa is essential for accurate diagnosis and risk stratification. However, the comprehension of its pathophysiological mechanisms remains not completely understood. The cGAS-STING-TFEB axis may explain the unique immunophenotype of the cellular element composing these neoplasms. Furthermore, this pathway could also be related to the unexpected presence of autophagy observed in angiomyolipoma/PEComa, with STING representing the missing piece in this intricate puzzle. Nevertheless, this proposed mechanism requires validation through further research.

Purpose of review: We try to highlight the most current testing methods in uropathology. Most of these tests are not fully approved, but nevertheless have found their way to daily routine.

Recent findings: In the bladder, testing is mainly based on immunohistochemistry and somatic testing. Other organs such as the prostate, the kidney, and the testis require sometimes different methods.

Summary: Although pathology is still the gold standard in diagnosis of tumor for patients in uropathology, many clinicians want to improve treatment options and try to tailor personalized treatments. This is of course depending not only on the available treatment options, but also on the somatic or germcell background of the patient and his tumor.