European urology focus最新文献

Background and objective: Prostate-specific-membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) is more accurate than conventional imaging for lymph node (LN) staging in prostate cancer. However, it has limitations in detecting micrometastatic lymph node invasion (LNI). Our aim was to evaluate the accuracy of PSMA PET/CT for overall and size-dependent LNI detection in contemporary patients undergoing radical prostatectomy (RP) and pelvic lymph node dissection (PLND).

Methods: Within a high-volume center database, we identified 873 patients who underwent PSMA PET/CT for primary staging before RP and PLND between 2016 and 2021. Data for lymph node status on imaging and histology results were analyzed.

Key findings and limitations: Of 873 patients, 25% (n = 220) had LNI. Median prostate-specific antigen was 8.3 ng/ml (interquartile range 4.3-14.3). The majority of patients had high-risk (53%) or intermediate-risk disease (45%). In the overall cohort, the per-patient sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy calculated for LNI detection via PSMA PET/CT were 45.5%, 92.6%, 67.6%, 83.4%, and 80.8%, respectively. The median metastatic LN size in the group of 120 patients with false-negative PET/CT results was 2.5 mm. For metastatic LNs ≥5 mm, the sensitivity and NPV increased to 68.8% (+23.3%) and 95.4% (+12.0%), respectively. The main limitation is the lack of central review of PSMA PET/CT scans.

Conclusions and clinical implications: PSMA PET/CT is accurate in the staging of pelvic LNs before RP, especially for detection of metastases in LNs with a diameter ≥5 mm.

Background and objective: Data about the mid- and long-term oncologic outcomes of endoscopic kidney-sparing surgery (eKSS) for upper tract urothelial carcinoma (UTUC) are scarce. Therefore, we aimed to summarize the current evidence on the oncologic outcomes of eKSS for UTUC.

Methods: A literature search was conducted to identify reports published until May 2024. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The outcomes were the following: recurrence-free (RFS), intravesical recurrence-free (IV-RFS), progression-free (PFS), cancer-specific (CSS), and overall (OS) survival.

Key findings and limitations: We found 56 studies (n = 52 retrospective) that met our inclusion criteria (n = 2862 patients). The 1-, 2-, 5-, and 10-yr OS rates were 96%, 87%, 80%, and 42%, respectively. The 1-, 2-, 5-, and 10-yr CSS rates were 97%, 89%, 82%, and 69%, respectively. RFS rates at 1, 2, and 5 yr were 69%, 55%, and 45%, respectively. IV-RFS rates at 1, 2, and 5 yr were 80%, 65%, and 64%, respectively. PFS rates at 2 and 5 yr were 75% and 69%, respectively. In low-grade UTUC, OS rates at 2 and 5 yr were 93% and 77%, respectively. The 2- and 5-yr CSS rates were 98% and 88%, respectively. At 2 yr, RFS, IV-RFS, and PFS were 52%, 54%, and 94%, respectively. For high-grade UTUC, only three studies reported data on 2-yr RFS, which was 34%. The main limitation is the heterogeneity found across the studies.

Conclusions and clinical implications: Local recurrence, bladder recurrence, and progression of UTUC occur mainly within 2 yr after eKSS. After 5-yr follow-up, OS and CSS drop, while the risk of local recurrence is non-negligible.

Background and objective: There is an established association between secondary bladder cancers (SBCs) and radiotherapy (RT) for prostate cancer (PC), which remains a significant concern. Our aim was to update the evidence on SBC incidence across different RT modalities and to compare oncological outcomes for patients diagnosed with SBC to those diagnosed with primary bladder cancer (PBC).

Methods: We searched MEDLINE, Scopus, and Web of Science for studies on SBC following PC. Pairwise meta-analyses were conducted to compare SBC incidence in terms of odds ratios (ORs) between RT modalities (external beam radiation therapy [EBRT], brachytherapy [BT], and BT + EBRT) and PBC incidence after radical prostatectomy (RP). SBC incidence data are presented as proportions, and pairwise meta-analyses were used to compare overall survival (OS) between SBC and PBC using hazard ratios (HRs).

Key findings and limitations: Thirty-one studies (n = 576 341) were included. All RT modalities significantly increased the risk of SBC in comparison to RP at all time points investigated. BT alone had similar long-term SBC risk in comparison to EBRT (OR 0.56, 95% confidence interval [CI] 0.25-1.23 at 10 yr; OR 0.51, 95% CI 0.24-1.06 at 15 yr). There was no significant difference in OS between SBC and PBC in the overall cohort. However, among patients requiring radical cystectomy (RC), SBC resulted in a significant decrease in OS in comparison to PBC (HR 1.55, 95% CI 1.06-2.26; p = 0.02).

Conclusions and clinical implications: All RT modalities increased the risk of SBC at each post-RT time point investigated. SBC patients requiring RC have worse survival than those with PBC. Our results highlight the need for ongoing surveillance and early detection. Despite the rarity of SBC, clinicians should monitor bladder symptoms in PC patients after RT. These data need to be included in the shared decision-making process with patients regarding therapeutic decisions to raise awareness of SBC in this setting.

For selected endourological interventions, local anesthesia provides an alternative to general anesthesia and can avoid complications and reduce turnover times and health care costs. Virtual reality (VR) has emerged as a promising nonpharmacological adjunct with potential to improve local anesthesia tolerability. This mini-review examines the role of VR during urological procedures under local anesthesia. Ten studies were included from 559 screened articles. For more invasive procedures, VR use was often associated with significant pain and anxiety reductions, while other studies reported minimal effects. VR effectiveness varied according to the invasiveness of the procedure, patient anxiety, and VR content. While VR shows potential in urology, further research is needed to confirm its effectiveness across various interventions. PATIENT SUMMARY: We reviewed studies on the use of virtual reality to reduce pain and anxiety during urological procedures. The current evidence shows promise, but more studies in urology are needed in this emerging field.

We analyzed data for a cohort of 111 patients with EMBARK-like biochemical recurrence (BCR) of prostate cancer (prostate-specific antigen [PSA] doubling time ≤9 mo, PSA ≥1 ng/ml) after radical prostatectomy and localized oligorecurrence on prostate-specific membrane antigen (PSMA)-based imaging. All patients underwent PSMA-radioguided surgery (RGS). At PSMA-RGS, the median PSA was 1.95 ng/ml (interquartile range [IQR] 1.36-3.20) ng/ml and the median PSA doubling time was 4.0 mo (IQR 2.5-5.5). Clavien-Dindo grade >IIIa complications occurred in nine of 111 patients (8.1%). A complete biochemical response (cBR; PSA decline ≤0.2 ng/ml after PSMA-RGS) was observed in 53 patients (47.7%). In the cBR group (equivalent to the treatment suspension criterion in EMBARK), estimated survival rates at 2 yr were 49.9% (95% confidence interval [CI] 37.2-67.1%) for BCR-free survival and 65.2% (95% CI 52.2-81.4%) for treatment-free survival. A relevant proportion of our PSMA-RGS cohort with localized oligorecurrence on PSMA-based imaging fulfilled the EMBARK criteria. PSMA-RGS yielded meaningful biochemical responses that translated to long-lasting treatment-free periods. PATIENT SUMMARY: For some patients with prostate cancer and no evidence of metastasis on conventional imaging but high risk of metastatic progression, modern molecular imaging identifies small cancer deposits that can be removed via targeted surgery. This surgery led to a significant decrease in PSA (prostate-specific antigen) levels, which allowed a longer break from further treatment.

Benign prostatic hyperplasia is a prevalent condition leading to male lower urinary tract symptoms (mLUTS), particularly in aging populations. Current management strategies-spanning watchful waiting, pharmaceutical therapy, and surgical interventions such as transurethral resection of the prostate-face significant limitations, including side effects, low adherence, and patient hesitancy toward invasive treatments. First-line interventional therapy (FIT) emerges as a novel paradigm bridging the gap between medications and surgery. FIT aims to provide effective, minimally invasive symptom relief with rapid recovery, minimal side effects, and preserved treatment adaptability. Recent advancements in minimally invasive surgical therapies (MISTs) highlight potential; yet existing MIST procedures often fall short of meeting the FIT criteria. An ideal FIT would integrate outpatient feasibility, durability, and patient-centered outcomes, addressing both urologist and patient expectations. By reimagining treatment pathways, FIT has the potential to revolutionize mLUTS management, shifting the standard of care toward early, effective, and patient-friendly interventions, ultimately improving quality of life and long-term bladder health. PATIENT SUMMARY: In this report, we explored new treatment options for men with urinary symptoms caused by an enlarged prostate. We found that many men avoid surgery due to its risks and side effects, while medications often have limited success and unwanted effects. We suggest a new type of treatment, called first-line interventional therapy, which could provide faster symptom relief with fewer risks and quicker recovery, offering a better option for many patients.