Pub Date : 2026-01-01DOI: 10.1016/j.euf.2025.07.016
Mikolaj Filon, Bogdana Schmidt
Antibody-drug conjugates (ADCs) have recently transformed the paradigm for metastatic urothelial carcinoma treatment. As these therapies demonstrate increasing efficacy and tolerability, attention is turning toward their use in earlier stages of disease. The current molecular targets for ADCs featured in large-scale trials have been Nectin-4 and TROP-2, leading to the development of enfortumab vedotin and sacituzumab govitecan; however, additional promising targets under investigation include HER2, FGFR3, EGFR, and CD-44. While identification of these targets is exciting, the next challenge is harnessing delivery mechanisms to maximize local responses, while limiting systemic toxicity. ADCs have the potential to enhance our ability to offer bladder-sparing therapies to patients with refractory non–muscle-invasive and potentially muscle-invasive disease, who were previously relying on radical cystectomy for treatment. ADCs represent an emerging frontier in the therapeutic landscape of urothelial carcinoma. While their use has thus far been limited to advanced disease, ongoing clinical trials and emerging data suggest possible expanded applications for ADCs in localized bladder cancer.
Patient summary
A new standard has emerged for metastatic urothelial carcinoma treatment with the combination of immunotherapy and antibody-drug conjugates. The use of these agents has the potential to transform the space of localized bladder cancer. While promising, many questions remain unanswered about how these new agents will be integrated into the treatment paradigm of non–muscle-invasive and localized muscle-invasive disease.
{"title":"The Future of Novel Antibody-drug Conjugates in Localized Urothelial Cancer","authors":"Mikolaj Filon, Bogdana Schmidt","doi":"10.1016/j.euf.2025.07.016","DOIUrl":"10.1016/j.euf.2025.07.016","url":null,"abstract":"<div><div>Antibody-drug conjugates (ADCs) have recently transformed the paradigm for metastatic urothelial carcinoma treatment. As these therapies demonstrate increasing efficacy and tolerability, attention is turning toward their use in earlier stages of disease. The current molecular targets for ADCs featured in large-scale trials have been Nectin-4 and TROP-2, leading to the development of enfortumab vedotin and sacituzumab govitecan; however, additional promising targets under investigation include HER2, FGFR3, EGFR, and CD-44. While identification of these targets is exciting, the next challenge is harnessing delivery mechanisms to maximize local responses, while limiting systemic toxicity. ADCs have the potential to enhance our ability to offer bladder-sparing therapies to patients with refractory non–muscle-invasive and potentially muscle-invasive disease, who were previously relying on radical cystectomy for treatment. ADCs represent an emerging frontier in the therapeutic landscape of urothelial carcinoma. While their use has thus far been limited to advanced disease, ongoing clinical trials and emerging data suggest possible expanded applications for ADCs in localized bladder cancer.</div></div><div><h3>Patient summary</h3><div>A new standard has emerged for metastatic urothelial carcinoma treatment with the combination of immunotherapy and antibody-drug conjugates. The use of these agents has the potential to transform the space of localized bladder cancer. While promising, many questions remain unanswered about how these new agents will be integrated into the treatment paradigm of non–muscle-invasive and localized muscle-invasive disease.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 1","pages":"Pages 34-37"},"PeriodicalIF":5.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741685","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}
Pub Date : 2026-01-01DOI: 10.1016/j.euf.2025.03.021
Viktor Grünwald , Thomas Powles , Thomas E. Hutson , Jens Bedke , Camillo Porta , Robert J. Motzer
{"title":"Re: Justine Panian, Caiwei Zhong, Sharon H. Choi, et al. Efficacy of Treatments After Lenvatinib in Patients with Advanced Renal Cell Carcinoma. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2024.11.011","authors":"Viktor Grünwald , Thomas Powles , Thomas E. Hutson , Jens Bedke , Camillo Porta , Robert J. Motzer","doi":"10.1016/j.euf.2025.03.021","DOIUrl":"10.1016/j.euf.2025.03.021","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 1","pages":"Pages 147-148"},"PeriodicalIF":5.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998387","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}
Pub Date : 2026-01-01DOI: 10.1016/j.euf.2025.07.011
Martina Maggi , Francesco Chierigo , Giuseppe Fallara , Letizia Maria Ippolita Jannello , Marco Tozzi , Francesco Pellegrino , Felice Crocetto , Daniela Terracciano , Roberto Bianchi , Matteo Ferro
Bladder cancer (BC) ranks among the tenth most common cancers globally, and its management remains a significant challenge for both patients and clinicians in terms of care delivery and decision-making process. The integration of artificial intelligence (AI) tools—primarily machine learning and deep learning methods—into the current BC workflow offers an opportunity for a more personalized approach to treatment. This article provides a brief overview of AI applications across different steps of BC management (ie, detection, grading, staging, risk stratification, treatment, and outcome prediction), highlighting its potential to contribute to individualized management strategies. Despite significant advances, major barriers still impede broad applications of AI in BC clinical workflows. Overcoming these obstacles is critical to realize the full potential of AI-driven personalization of BC care in the coming decade.
Patient summary
Our mini review summarizes how artificial intelligence (ie, a machine’s ability to mimic human intelligence to perform tasks involving decision-making and problem-solving) has been applied to the management of bladder cancer, and whether it could lead to more precise treatment for patients diagnosed with this disease. Although several promising applications have been developed, more studies are necessary before these can be used in routine clinical practice.
{"title":"Shaping the Future of Personalized Therapy in Bladder Cancer Using Artificial Intelligence","authors":"Martina Maggi , Francesco Chierigo , Giuseppe Fallara , Letizia Maria Ippolita Jannello , Marco Tozzi , Francesco Pellegrino , Felice Crocetto , Daniela Terracciano , Roberto Bianchi , Matteo Ferro","doi":"10.1016/j.euf.2025.07.011","DOIUrl":"10.1016/j.euf.2025.07.011","url":null,"abstract":"<div><div>Bladder cancer (BC) ranks among the tenth most common cancers globally, and its management remains a significant challenge for both patients and clinicians in terms of care delivery and decision-making process. The integration of artificial intelligence (AI) tools—primarily machine learning and deep learning methods—into the current BC workflow offers an opportunity for a more personalized approach to treatment. This article provides a brief overview of AI applications across different steps of BC management (ie, detection, grading, staging, risk stratification, treatment, and outcome prediction), highlighting its potential to contribute to individualized management strategies. Despite significant advances, major barriers still impede broad applications of AI in BC clinical workflows. Overcoming these obstacles is critical to realize the full potential of AI-driven personalization of BC care in the coming decade.</div></div><div><h3>Patient summary</h3><div>Our mini review summarizes how artificial intelligence (ie, a machine’s ability to mimic human intelligence to perform tasks involving decision-making and problem-solving) has been applied to the management of bladder cancer, and whether it could lead to more precise treatment for patients diagnosed with this disease. Although several promising applications have been developed, more studies are necessary before these can be used in routine clinical practice.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 1","pages":"Pages 41-48"},"PeriodicalIF":5.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768569","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}
Pub Date : 2026-01-01DOI: 10.1016/j.euf.2025.05.008
Guru P. Sonpavde
{"title":"Role of Adjuvant Therapy in Current Perioperative Immunotherapy-based Trials in Bladder Cancer: A Justified Standard","authors":"Guru P. Sonpavde","doi":"10.1016/j.euf.2025.05.008","DOIUrl":"10.1016/j.euf.2025.05.008","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 1","pages":"Pages 7-9"},"PeriodicalIF":5.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141948","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}
Pub Date : 2026-01-01DOI: 10.1016/j.euf.2025.03.023
Yu-Hsiang Lin , Yi-Kai Chang , Kuo-Jen Lin
{"title":"Re: Guillermo Conde-Santos, Barbara Padilla-Fernández. Targeting the Autonomic Nervous System for Treatment of Urinary Incontinence. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.02.015","authors":"Yu-Hsiang Lin , Yi-Kai Chang , Kuo-Jen Lin","doi":"10.1016/j.euf.2025.03.023","DOIUrl":"10.1016/j.euf.2025.03.023","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 1","pages":"Page 151"},"PeriodicalIF":5.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959880","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}
Pub Date : 2026-01-01DOI: 10.1016/j.euf.2025.11.016
Abdullah Al-Khanaty , David Hennes , Marlon L. Perera , Nathan Lawrentschuk , Declan G. Murphy , Renu S. Eapen
High-risk localised and locally advanced prostate cancer (PC) accounts for nearly 25% of new PC diagnoses and is associated with significantly greater mortality in comparison to lower-risk disease. Radical prostatectomy (RP) remains central to curative treatment, but many patients experience biochemical relapse or develop metastases within a decade, which reflects undetected micrometastatic disease at diagnosis. The perioperative period offers an opportunity to intensify systemic therapy and potentially improve long-term outcomes. Early neoadjuvant trials of first-generation androgen deprivation therapy improved pathological findings, but not survival. Chemotherapy with docetaxel is feasible, with some evidence of a long-term benefit, but data for short-term endpoints remain inconclusive. The strongest evidence is from trials of androgen receptor pathway inhibitors, which have revealed pathological downstaging, biological activity, and translational insights; the phase 3 PROTEUS trial will determine the impact of these agents on survival. Radioligand therapy with [177Lu]-labelled prostate-specific membrane antigen ligands and genomically guided approaches are feasible and safe, but remain exploratory. Currently, no phase 3 data support systemic neoadjuvant therapy before RP, and this strategy is not recommended by international guidelines. Ongoing and future large-scale trials will be critical to define the role of neoadjuvant therapy in this PC setting in clinical practice.
Patient summary
We reviewed studies of systemic therapies given before surgery for men with high-risk prostate cancer. These treatments can shrink tumours and improve surgical outcomes, but clear survival benefits have not yet been shown. Ongoing large trials, especially with new hormone-blocking drugs, will help in determining if this approach should become part of routine care.
{"title":"Neoadjuvant Systemic Therapy in High-risk Localised Prostate Cancer: Current Evidence and Future Directions","authors":"Abdullah Al-Khanaty , David Hennes , Marlon L. Perera , Nathan Lawrentschuk , Declan G. Murphy , Renu S. Eapen","doi":"10.1016/j.euf.2025.11.016","DOIUrl":"10.1016/j.euf.2025.11.016","url":null,"abstract":"<div><div>High-risk localised and locally advanced prostate cancer (PC) accounts for nearly 25% of new PC diagnoses and is associated with significantly greater mortality in comparison to lower-risk disease. Radical prostatectomy (RP) remains central to curative treatment, but many patients experience biochemical relapse or develop metastases within a decade, which reflects undetected micrometastatic disease at diagnosis. The perioperative period offers an opportunity to intensify systemic therapy and potentially improve long-term outcomes. Early neoadjuvant trials of first-generation androgen deprivation therapy improved pathological findings, but not survival. Chemotherapy with docetaxel is feasible, with some evidence of a long-term benefit, but data for short-term endpoints remain inconclusive. The strongest evidence is from trials of androgen receptor pathway inhibitors, which have revealed pathological downstaging, biological activity, and translational insights; the phase 3 PROTEUS trial will determine the impact of these agents on survival. Radioligand therapy with [<sup>177</sup>Lu]-labelled prostate-specific membrane antigen ligands and genomically guided approaches are feasible and safe, but remain exploratory. Currently, no phase 3 data support systemic neoadjuvant therapy before RP, and this strategy is not recommended by international guidelines. Ongoing and future large-scale trials will be critical to define the role of neoadjuvant therapy in this PC setting in clinical practice.</div></div><div><h3>Patient summary</h3><div>We reviewed studies of systemic therapies given before surgery for men with high-risk prostate cancer. These treatments can shrink tumours and improve surgical outcomes, but clear survival benefits have not yet been shown. Ongoing large trials, especially with new hormone-blocking drugs, will help in determining if this approach should become part of routine care.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 1","pages":"Pages 24-27"},"PeriodicalIF":5.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700043","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}
Pub Date : 2026-01-01DOI: 10.1016/j.euf.2025.11.015
Neal D. Shore , Stephen J. Freedland , Lisa G. Horvath , Joe M. O’Sullivan , Ugo De Giorgi , Edward C. Ray , Ashley E. Ross , Yiyun Tang , David Russell , Kenneth K. Iwata , Matt Rosales , Arijit Ganguli , Bertrand Tombal
Background and objective
Enzalutamide (Enza) is the only androgen receptor pathway inhibitor approved as monotherapy for high-risk biochemically recurrent prostate cancer. Breast-related adverse events (BRAEs) are common among patients treated with Enza monotherapy (Enza-Mono). We review relevant clinical trial data, including unpublished data, on measures to prevent BRAEs. Given the absence of data on mitigating strategies for Enza-associated BRAEs, we draw on pertinent prophylactic strategies used in studies of bicalutamide, a nonsteroidal antiandrogen with a similar mechanism of action. We critically discuss the clinical implications of such strategies to support decision-making in patients receiving Enza-Mono.
Methods
We searched PubMed for clinical trials on the safety of Enza-Mono, with a focus on BRAEs. We added relevant unpublished data from the EMBARK and ENACT trials. We also explored the literature and summarize prophylactic strategies for bicalutamide-induced BRAEs.
Key findings and limitations
In three trials involving 533 patients treated with Enza-Mono, Enza-Mono (160 mg/d) was commonly associated with gynecomastia (37–49%), breast pain or tenderness (14–26%), and/or nipple pain (15–30%). No prophylactic measures for BRAEs were protocol-specified in these studies. Previous studies with bicalutamide (150 mg/d) reported the benefits and relative tolerability of prophylactic radiation therapy and/or tamoxifen or prophylactic anastrozole to mitigate gynecomastia or breast pain.
Conclusions and clinical implications
Given the absence of data on prophylactic strategies for Enza-associated BRAEs, findings from bicalutamide studies could be extrapolated to Enza-Mono. Prospective trials are needed to optimize prophylactic strategies for BRAEs with Enza-Mono.
{"title":"Strategies to Mitigate Breast-related Adverse Events in Patients with High-risk Biochemically Recurrent Prostate Cancer Receiving Enzalutamide Monotherapy: Perspectives and Challenges","authors":"Neal D. Shore , Stephen J. Freedland , Lisa G. Horvath , Joe M. O’Sullivan , Ugo De Giorgi , Edward C. Ray , Ashley E. Ross , Yiyun Tang , David Russell , Kenneth K. Iwata , Matt Rosales , Arijit Ganguli , Bertrand Tombal","doi":"10.1016/j.euf.2025.11.015","DOIUrl":"10.1016/j.euf.2025.11.015","url":null,"abstract":"<div><h3>Background and objective</h3><div>Enzalutamide (Enza) is the only androgen receptor pathway inhibitor approved as monotherapy for high-risk biochemically recurrent prostate cancer. Breast-related adverse events (BRAEs) are common among patients treated with Enza monotherapy (Enza-Mono). We review relevant clinical trial data, including unpublished data, on measures to prevent BRAEs. Given the absence of data on mitigating strategies for Enza-associated BRAEs, we draw on pertinent prophylactic strategies used in studies of bicalutamide, a nonsteroidal antiandrogen with a similar mechanism of action. We critically discuss the clinical implications of such strategies to support decision-making in patients receiving Enza-Mono.</div></div><div><h3>Methods</h3><div>We searched PubMed for clinical trials on the safety of Enza-Mono, with a focus on BRAEs. We added relevant unpublished data from the EMBARK and ENACT trials. We also explored the literature and summarize prophylactic strategies for bicalutamide-induced BRAEs.</div></div><div><h3>Key findings and limitations</h3><div>In three trials involving 533 patients treated with Enza-Mono, Enza-Mono (160 mg/d) was commonly associated with gynecomastia (37–49%), breast pain or tenderness (14–26%), and/or nipple pain (15–30%). No prophylactic measures for BRAEs were protocol-specified in these studies. Previous studies with bicalutamide (150 mg/d) reported the benefits and relative tolerability of prophylactic radiation therapy and/or tamoxifen or prophylactic anastrozole to mitigate gynecomastia or breast pain.</div></div><div><h3>Conclusions and clinical implications</h3><div>Given the absence of data on prophylactic strategies for Enza-associated BRAEs, findings from bicalutamide studies could be extrapolated to Enza-Mono. Prospective trials are needed to optimize prophylactic strategies for BRAEs with Enza-Mono.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 1","pages":"Pages 131-143"},"PeriodicalIF":5.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793738","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}
Pub Date : 2026-01-01DOI: 10.1016/j.euf.2025.07.003
Scott M. Gilbert
{"title":"What Is the Optimal Perioperative Treatment for Variant Subtypes of Bladder Cancer?","authors":"Scott M. Gilbert","doi":"10.1016/j.euf.2025.07.003","DOIUrl":"10.1016/j.euf.2025.07.003","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 1","pages":"Pages 22-23"},"PeriodicalIF":5.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706907","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}
Pub Date : 2026-01-01DOI: 10.1016/j.euf.2025.04.015
Nicola Frego , Francesco Barletta , Mario de Angelis , Stefano Resca , Enrico Vecchio , Sara Tamburini , Alessandro Pissavini , Andrea Noya Mourullo , Claudio Brancelli , Edward Lambert , Frederick D’Hondt , Ruben De Groote , Giorgio Gandaglia , Geert De Naeyer , Alberto Briganti , Francesco Montorsi , Alexandre Mottrie
Background and objective
Preservation of neurovascular bundles (NVBs) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) has been associated with better functional outcomes. The aim of this study is to investigate the oncological impact of NVB preservation in patients with high-risk PCa.
Methods
D’Amico high-risk PCa patients who underwent RP between 2002 and 2022 at two high-volume referral centers were included in the study analysis. Patients who underwent neoadjuvant and adjuvant therapy as well as those with evidence of M1 or pT4 disease were excluded. Propensity score and inverse probability of treatment weighting were used to account for a selection bias in treatment allocation. A time-to-event analysis was performed to assess the effect of NVB preservation on biochemical (BCR) and clinical (CR) recurrences.
Key findings and limitations
Overall, 1551 high-risk PCa patients were included in the analysis (56.8% and 43.2% underwent preservation of NVBs vs no NVBs). After applying the inverse probability of treatment weighting, at 120 mo after RP, BCR- and CR-free survival rates were 27.1% versus 27.5% and 58.9% versus 58.4% for the preservation of NVBs versus no NVBs, respectively. In the models adjusted for pathological characteristics, age, and prostate-specific antigen density, NVB preservation was not associated with a significantly higher risk of BCR (adjusted hazard ratio [aHR]: 0.79, 95% confidence interval [CI]: 0.56–1.11, p = 0.2) and CR (aHR: 0.78, 95% CI: 0.45–1.32, p = 0.4), compared with no NVB preservation. In the subgroup analysis of pathological International Society of Urological Pathology grade 4–5 and/or pT stage 3a-3b patients, NVB preservation did not make oncological outcomes worse at both univariable and multivariable cox analyses.
Conclusions and clinical implications
NVB preservation might have a limited effect on the risk of BCR and CR compared with no preservation. Nerve-sparing surgery may be attempted in selected high-risk PCa patients without compromising long-term oncological outcome.
背景与目的：行根治性前列腺切除术（RP）的前列腺癌（PCa）患者保存神经血管束（NVBs）与更好的功能预后相关。本研究的目的是探讨NVB保留对高危前列腺癌患者的肿瘤学影响。方法：研究分析纳入了2002年至2022年间在两个大容量转诊中心接受RP的D'Amico高危PCa患者。接受新辅助和辅助治疗的患者以及有M1或pT4疾病证据的患者被排除在外。倾向得分和治疗加权逆概率用于解释治疗分配中的选择偏差。通过时间-事件分析来评估NVB保存对生化（BCR）和临床（CR）复发的影响。主要发现和局限性：总体而言，1551例高风险PCa患者被纳入分析（56.8%和43.2%的患者接受了NVBs保存，而没有接受NVBs）。在应用治疗加权逆概率后，RP后120个月，保留NVBs和无NVBs的BCR和无cr生存率分别为27.1%对27.5%和58.9%对58.4%。在对病理特征、年龄和前列腺特异性抗原密度进行校正的模型中，与未保存NVB相比，保存NVB与BCR（校正风险比[aHR]: 0.79, 95%可信区间[CI]: 0.56-1.11, p = 0.2）和CR （aHR: 0.78, 95% CI: 0.45-1.32, p = 0.4）的风险没有显著升高。在国际泌尿病理学会病理分级4-5和/或pT期3a-3b患者的亚组分析中，在单变量和多变量cox分析中，NVB保存并未使肿瘤预后恶化。结论和临床意义：与不保存相比，保存NVB对BCR和CR的风险影响有限。在不影响长期肿瘤预后的情况下，可以选择高危PCa患者进行神经保留手术。
{"title":"Preservation of Neurovascular Bundles in High-risk Prostate Cancer Patients: Long-term Oncological Outcomes from Two High-volume Tertiary Centers","authors":"Nicola Frego , Francesco Barletta , Mario de Angelis , Stefano Resca , Enrico Vecchio , Sara Tamburini , Alessandro Pissavini , Andrea Noya Mourullo , Claudio Brancelli , Edward Lambert , Frederick D’Hondt , Ruben De Groote , Giorgio Gandaglia , Geert De Naeyer , Alberto Briganti , Francesco Montorsi , Alexandre Mottrie","doi":"10.1016/j.euf.2025.04.015","DOIUrl":"10.1016/j.euf.2025.04.015","url":null,"abstract":"<div><h3>Background and objective</h3><div>Preservation of neurovascular bundles (NVBs) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) has been associated with better functional outcomes. The aim of this study is to investigate the oncological impact of NVB preservation in patients with high-risk PCa.</div></div><div><h3>Methods</h3><div>D’Amico high-risk PCa patients who underwent RP between 2002 and 2022 at two high-volume referral centers were included in the study analysis. Patients who underwent neoadjuvant and adjuvant therapy as well as those with evidence of M1 or pT4 disease were excluded. Propensity score and inverse probability of treatment weighting were used to account for a selection bias in treatment allocation. A time-to-event analysis was performed to assess the effect of NVB preservation on biochemical (BCR) and clinical (CR) recurrences.</div></div><div><h3>Key findings and limitations</h3><div>Overall, 1551 high-risk PCa patients were included in the analysis (56.8% and 43.2% underwent preservation of NVBs vs no NVBs). After applying the inverse probability of treatment weighting, at 120 mo after RP, BCR- and CR-free survival rates were 27.1% versus 27.5% and 58.9% versus 58.4% for the preservation of NVBs versus no NVBs, respectively. In the models adjusted for pathological characteristics, age, and prostate-specific antigen density, NVB preservation was not associated with a significantly higher risk of BCR (adjusted hazard ratio [aHR]: 0.79, 95% confidence interval [CI]: 0.56–1.11, <em>p</em> = 0.2) and CR (aHR: 0.78, 95% CI: 0.45–1.32, <em>p</em> = 0.4), compared with no NVB preservation. In the subgroup analysis of pathological International Society of Urological Pathology grade 4–5 and/or pT stage 3a-3b patients, NVB preservation did not make oncological outcomes worse at both univariable and multivariable cox analyses.</div></div><div><h3>Conclusions and clinical implications</h3><div>NVB preservation might have a limited effect on the risk of BCR and CR compared with no preservation. Nerve-sparing surgery may be attempted in selected high-risk PCa patients without compromising long-term oncological outcome.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 1","pages":"Pages 51-60"},"PeriodicalIF":5.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985612","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}
Pub Date : 2026-01-01DOI: 10.1016/j.euf.2025.05.001
Yu-Hsiang Lin , Yu-Chen Chen , Jau-Yuan Chen
Overactive bladder (OAB) and nocturnal polyuria (NP) significantly impact quality of life, particularly in aging men with benign prostatic hyperplasia (BPH). While often managed as localized lower urinary tract issues, emerging evidence suggests a complex interplay involving systemic factors. This mini-review explores the hypothesis that BPH-induced sleep disruption, primarily via nocturia, can trigger a cascade involving central circadian dysregulation, subsequent autonomic nervous system (ANS) imbalance, and hormonal shifts (including antidiuretic hormone and testosterone) that ultimately contribute to OAB symptoms and NP. Conditions such as obstructive sleep apnea can exacerbate this cycle. Manifestations of ANS dysfunction, such as altered heart rate variability and nondipping blood-pressure patterns, are increasingly recognized in these patients. Current pharmacological treatments for OAB such as anticholinergic agents and β3-adrenoceptor agonists, may primarily address the downstream consequences of ANS dysregulation. This intricate network highlights the potential need for integrated management strategies targeting sleep, circadian health, and ANS balance alongside traditional urological approaches.
Patient summary
Older men often experience frequent nighttime urination (nocturia) associated with an enlarged prostate gland. This review discusses how the resulting poor sleep can disrupt the body’s internal clock and control of the nervous system. This disruption can worsen bladder problems such as overactive bladder and increase nighttime urine production, and can potentially affect heart rate patterns and blood pressure. This suggests that managing sleep and the body’s rhythms might be important alongside standard bladder treatments for these patients.
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