Pub Date : 2024-12-01Epub Date: 2024-05-24DOI: 10.1016/j.euf.2024.05.010
Vineet Gauhar, Olivier Traxer, Daniele Castellani, Christian Sietz, Ben Hall Chew, Khi Yung Fong, Saeed Bin Hamri, Mehmet Ilker Gökce, Nariman Gadzhiev, Andrea Benedetto Galosi, Steffi Kar Kei Yuen, Albert El Hajj, Raymond Ko, Marek Zawadzki, Vikram Sridharan, Mohamed Amine Lakmichi, Mariela Corrales, Vigen Malkhasyan, Deepak Ragoori, Boyke Soebhali, Karl Tan, Chu Ann Chai, Azimdjon N Tursunkulov, Yiloren Tanidir, Satyendra Persaud, Mohamed Elshazly, Wissam Kamal, Tzevat Tefik, Anil Shrestha, Heng Chin Tiong, Bhaskar Kumar Somani
Background and objective: The aim of this study was to evaluate the stone-free status (SFS) rate and complications after flexible ureteroscopy (fURS) for treatment of renal stones using a flexible and navigable suction (FANS) ureteral access sheath.
Methods: Data for adults undergoing fURS in 25 centers worldwide were prospectively collected (August 2023 to January 2024). Exclusion criteria were abnormal renal anatomy and ureteral stones. All patients had computed tomography scans before and within 30 d after fURS with a FANS ureteral access sheath. SFS was defined as follows: grade A, zero fragments; grade B, a single fragment ≤2 mm; grade C, a single fragment 2.1-4 mm; and grade D, single/multiple fragments >4 mm. Data for continuous variables are presented as the median and interquartile range (IQR). Multivariable logistic regression was performed to evaluate predictors of grade A SFS.
Key findings and limitations: The study enrolled 394 patients (59.1% male) with a median age of 49 yr (IQR 36-61). The median stone volume was 1260 mm3 (IQR 706-1800). Thulium fiber laser (TFL) was used in 45.9% of cases and holmium laser in the rest. The median lasing time was 18 min (IQR 11-28) and the median operative time was 49 min (IQR 37-70). One patient required a blood transfusion and 3.3% of patients had low-grade fever. No patient developed sepsis. Low-grade ureteral injury occurred in eight patients (2%). The grade A SFS rate was 57.4% and the grade A + B SFS rate was 97.2%, while 2.8% of patients had grade C or D SFS. Eleven patients underwent repeat fURS. Multivariable analysis revealed that a stone volume of 1501-3000 mm3 (odds ratio 0.50) and of >3000 mm3 (odds ratio 0.29) were significantly associated with lower probability of grade A SFS, while TFL use was associated with higher SFS probability (odds ratio 1.83). Limitations include the lack of a comparative group.
Conclusions and clinical implications: fURS using a FANS ureteral access sheath resulted in a high SFS rate with negligible serious adverse event and reintervention rates.
Patient summary: We looked at 30-day results for patients undergoing telescopic laser treatment for kidney stones using a special type of vacuum-assisted sheath to remove stone fragments. We found a high stone-free rate with minimal complications.
{"title":"Could Use of a Flexible and Navigable Suction Ureteral Access Sheath Be a Potential Game-changer in Retrograde Intrarenal Surgery? Outcomes at 30 Days from a Large, Prospective, Multicenter, Real-world Study by the European Association of Urology Urolithiasis Section.","authors":"Vineet Gauhar, Olivier Traxer, Daniele Castellani, Christian Sietz, Ben Hall Chew, Khi Yung Fong, Saeed Bin Hamri, Mehmet Ilker Gökce, Nariman Gadzhiev, Andrea Benedetto Galosi, Steffi Kar Kei Yuen, Albert El Hajj, Raymond Ko, Marek Zawadzki, Vikram Sridharan, Mohamed Amine Lakmichi, Mariela Corrales, Vigen Malkhasyan, Deepak Ragoori, Boyke Soebhali, Karl Tan, Chu Ann Chai, Azimdjon N Tursunkulov, Yiloren Tanidir, Satyendra Persaud, Mohamed Elshazly, Wissam Kamal, Tzevat Tefik, Anil Shrestha, Heng Chin Tiong, Bhaskar Kumar Somani","doi":"10.1016/j.euf.2024.05.010","DOIUrl":"10.1016/j.euf.2024.05.010","url":null,"abstract":"<p><strong>Background and objective: </strong>The aim of this study was to evaluate the stone-free status (SFS) rate and complications after flexible ureteroscopy (fURS) for treatment of renal stones using a flexible and navigable suction (FANS) ureteral access sheath.</p><p><strong>Methods: </strong>Data for adults undergoing fURS in 25 centers worldwide were prospectively collected (August 2023 to January 2024). Exclusion criteria were abnormal renal anatomy and ureteral stones. All patients had computed tomography scans before and within 30 d after fURS with a FANS ureteral access sheath. SFS was defined as follows: grade A, zero fragments; grade B, a single fragment ≤2 mm; grade C, a single fragment 2.1-4 mm; and grade D, single/multiple fragments >4 mm. Data for continuous variables are presented as the median and interquartile range (IQR). Multivariable logistic regression was performed to evaluate predictors of grade A SFS.</p><p><strong>Key findings and limitations: </strong>The study enrolled 394 patients (59.1% male) with a median age of 49 yr (IQR 36-61). The median stone volume was 1260 mm<sup>3</sup> (IQR 706-1800). Thulium fiber laser (TFL) was used in 45.9% of cases and holmium laser in the rest. The median lasing time was 18 min (IQR 11-28) and the median operative time was 49 min (IQR 37-70). One patient required a blood transfusion and 3.3% of patients had low-grade fever. No patient developed sepsis. Low-grade ureteral injury occurred in eight patients (2%). The grade A SFS rate was 57.4% and the grade A + B SFS rate was 97.2%, while 2.8% of patients had grade C or D SFS. Eleven patients underwent repeat fURS. Multivariable analysis revealed that a stone volume of 1501-3000 mm<sup>3</sup> (odds ratio 0.50) and of >3000 mm<sup>3</sup> (odds ratio 0.29) were significantly associated with lower probability of grade A SFS, while TFL use was associated with higher SFS probability (odds ratio 1.83). Limitations include the lack of a comparative group.</p><p><strong>Conclusions and clinical implications: </strong>fURS using a FANS ureteral access sheath resulted in a high SFS rate with negligible serious adverse event and reintervention rates.</p><p><strong>Patient summary: </strong>We looked at 30-day results for patients undergoing telescopic laser treatment for kidney stones using a special type of vacuum-assisted sheath to remove stone fragments. We found a high stone-free rate with minimal complications.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":"975-982"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141092943","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 : 2024-12-01Epub Date: 2024-08-01DOI: 10.1016/j.euf.2024.07.004
Brian Sheng Yep Yeo, Dominic Wei Ting Yap, Nicole Kye Wen Tan, Benjamin Kye Jyn Tan, Yao Hao Teo, Yao Neng Teo, Alvin Lee, Anna See, Henry Sun Sien Ho, Jeremy Yuen-Chun Teoh, Kenneth Chen, Song Tar Toh
Background and objective: While obstructive sleep apnea (OSA) and urological cancer are both strongly associated with hypoxia, controversy exists regarding their association with each other. This study aims to summarize and synthesize evidence to clarify the association between OSA and urological cancer incidence and mortality.
Methods: According to a prespecified protocol, PubMed, Embase, Cochrane Library, and Scopus were searched from inception to November 16, 2023, for observational and randomized studies reporting the association of OSA with urological cancer incidence or mortality. We pooled maximally covariate-adjusted hazard ratios (HRs) using a random-effects inverse variance-weighted model. Two reviewers independently assessed the quality of evidence using the Newcastle-Ottawa Scale and the Grading of Recommendations, Assessment, Development and Evaluation framework.
Key findings and limitations: From 1814 records, we included 12 studies comprising 9 290 818 participants in total, of which nine studies were analyzed quantitatively. OSA patients had an increased risk of kidney (HR: 1.75, 95% confidence interval [CI]: 1.21-2.53) and bladder (HR: 1.76, 95% CI: 1.05-2.96) cancer. However, OSA was not associated with prostate cancer incidence (HR: 1.29, 95% CI: 0.82-2.04). We systematically reviewed evidence surrounding OSA and testicular cancer incidence and urological cancer mortality.
Conclusions and clinical implications: OSA may be associated with a higher risk of kidney and bladder cancer, but not prostate cancer. Future work may help clarify the possibility of a dose-response relationship between OSA and urological cancer, and the effect of OSA treatment on urological cancer incidence or progression.
Patient summary: This research highlights a potential longitudinal association between OSA and kidney and bladder cancer, but not prostate cancer.
背景和目的:虽然阻塞性睡眠呼吸暂停(OSA)和泌尿系统癌症都与缺氧密切相关,但它们之间的关系却存在争议。本研究旨在总结和归纳证据,以澄清 OSA 与泌尿系统癌症发病率和死亡率之间的关系:根据预先确定的方案,我们检索了 PubMed、Embase、Cochrane Library 和 Scopus 上从开始到 2023 年 11 月 16 日报道 OSA 与泌尿系统癌症发病率或死亡率相关性的观察性和随机研究。我们采用随机效应反方差加权模型对最大协变量调整后的危险比(HRs)进行了汇总。两位评审员使用纽卡斯尔-渥太华量表和建议、评估、发展和评价分级框架独立评估了证据的质量:从 1814 份记录中,我们纳入了 12 项研究,共有 9 290 818 人参与,其中 9 项研究进行了定量分析。OSA患者罹患肾癌(HR:1.75,95% 置信区间[CI]:1.21-2.53)和膀胱癌(HR:1.76,95% 置信区间[CI]:1.05-2.96)的风险增加。但 OSA 与前列腺癌的发病率无关(HR:1.29,95% CI:0.82-2.04)。我们系统地回顾了有关 OSA 与睾丸癌发病率和泌尿系统癌症死亡率的证据:OSA可能与较高的肾癌和膀胱癌风险有关,但与前列腺癌无关。未来的工作可能有助于澄清 OSA 与泌尿系统癌症之间可能存在的剂量反应关系,以及 OSA 治疗对泌尿系统癌症发病率或进展的影响。患者总结:这项研究强调了 OSA 与肾癌和膀胱癌之间的潜在纵向联系,但与前列腺癌无关。
{"title":"The Association of Obstructive Sleep Apnea with Urological Cancer Incidence and Mortality-A Systematic Review and Meta-analysis.","authors":"Brian Sheng Yep Yeo, Dominic Wei Ting Yap, Nicole Kye Wen Tan, Benjamin Kye Jyn Tan, Yao Hao Teo, Yao Neng Teo, Alvin Lee, Anna See, Henry Sun Sien Ho, Jeremy Yuen-Chun Teoh, Kenneth Chen, Song Tar Toh","doi":"10.1016/j.euf.2024.07.004","DOIUrl":"10.1016/j.euf.2024.07.004","url":null,"abstract":"<p><strong>Background and objective: </strong>While obstructive sleep apnea (OSA) and urological cancer are both strongly associated with hypoxia, controversy exists regarding their association with each other. This study aims to summarize and synthesize evidence to clarify the association between OSA and urological cancer incidence and mortality.</p><p><strong>Methods: </strong>According to a prespecified protocol, PubMed, Embase, Cochrane Library, and Scopus were searched from inception to November 16, 2023, for observational and randomized studies reporting the association of OSA with urological cancer incidence or mortality. We pooled maximally covariate-adjusted hazard ratios (HRs) using a random-effects inverse variance-weighted model. Two reviewers independently assessed the quality of evidence using the Newcastle-Ottawa Scale and the Grading of Recommendations, Assessment, Development and Evaluation framework.</p><p><strong>Key findings and limitations: </strong>From 1814 records, we included 12 studies comprising 9 290 818 participants in total, of which nine studies were analyzed quantitatively. OSA patients had an increased risk of kidney (HR: 1.75, 95% confidence interval [CI]: 1.21-2.53) and bladder (HR: 1.76, 95% CI: 1.05-2.96) cancer. However, OSA was not associated with prostate cancer incidence (HR: 1.29, 95% CI: 0.82-2.04). We systematically reviewed evidence surrounding OSA and testicular cancer incidence and urological cancer mortality.</p><p><strong>Conclusions and clinical implications: </strong>OSA may be associated with a higher risk of kidney and bladder cancer, but not prostate cancer. Future work may help clarify the possibility of a dose-response relationship between OSA and urological cancer, and the effect of OSA treatment on urological cancer incidence or progression.</p><p><strong>Patient summary: </strong>This research highlights a potential longitudinal association between OSA and kidney and bladder cancer, but not prostate cancer.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":"958-971"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874553","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 : 2024-12-01Epub Date: 2024-06-26DOI: 10.1016/j.euf.2024.06.007
Daniele Robesti, Marco Moschini, Nazario Pio Tenace, Giusy Burgio, Chiara Re, Riccardo Leni, Mario De Angelis, Pietro Scilipoti, Francesco Pellegrino, Donato Cannoletta, Giorgio Gandaglia, Nicola Fossati, Andrea Gallina, Claudio Doglioni, Maurizio Colecchia, Andrea Salonia, Francesco Montorsi, Alberto Briganti, Roberta Lucianò
Background and objective: Pathological features in non-muscle-invasive bladder cancer specimens are pivotal in determining correct patients' therapeutic management. Sparse data exist regarding the importance of second opinion performed by an expert uropathologist. This study aimed to assess the importance of a second opinion by an expert uropathologist in the management of bladder cancer.
Methods: The study relied on 272 bladder cancer specimens from 231 patients seeking a pathology second opinion after transurethral resection of the bladder for a clinical suspicion of bladder cancer, relapse, or second-look procedure. Pathology second opinion was offered by an experienced fellowship-trained uropathologist. Discrepancies were recorded considering primary tumor staging, the presence of muscularis propria, and the presence of histological variants. Cases were categorized as no significant discordance, major discordance without management change, and major discordance with management change according to the European Urology Association (EAU) guidelines.
Key findings and limitations: Among 272 second opinion cases, 39% (108/272) had major discordance and 28% (75/272) had major discordance with change in management according to the EAU guidelines. Upstaging and downstaging were reported in 66 (24%) patients. Improper identification of the presence of muscularis propria was found in 46 (17%) cases, of which 11 (4%) were deemed clinically relevant. Differences regarding the presence of histological variants were diagnosed in 40 cases (15%), resulting in eight (3%) changes in clinical management. In ten specimens (4%), multiple clinically relevant discrepancies were found.
Conclusions and clinical implications: The second opinion evaluation changed the clinical management in 25% of the cases. These results support the importance of specimen review by an expert uropathologist as a major driver in the correct bladder cancer management.
Patient summary: We investigated the importance of a second opinion performed by an expert uropathologist in the management of bladder cancer. We found that 25% had their treatment plan changed due to the revised pathological report.
{"title":"The Impact of Second Opinion Expert Pathology Review in Patient Management at the Time of Transurethral Resection of the Bladder.","authors":"Daniele Robesti, Marco Moschini, Nazario Pio Tenace, Giusy Burgio, Chiara Re, Riccardo Leni, Mario De Angelis, Pietro Scilipoti, Francesco Pellegrino, Donato Cannoletta, Giorgio Gandaglia, Nicola Fossati, Andrea Gallina, Claudio Doglioni, Maurizio Colecchia, Andrea Salonia, Francesco Montorsi, Alberto Briganti, Roberta Lucianò","doi":"10.1016/j.euf.2024.06.007","DOIUrl":"10.1016/j.euf.2024.06.007","url":null,"abstract":"<p><strong>Background and objective: </strong>Pathological features in non-muscle-invasive bladder cancer specimens are pivotal in determining correct patients' therapeutic management. Sparse data exist regarding the importance of second opinion performed by an expert uropathologist. This study aimed to assess the importance of a second opinion by an expert uropathologist in the management of bladder cancer.</p><p><strong>Methods: </strong>The study relied on 272 bladder cancer specimens from 231 patients seeking a pathology second opinion after transurethral resection of the bladder for a clinical suspicion of bladder cancer, relapse, or second-look procedure. Pathology second opinion was offered by an experienced fellowship-trained uropathologist. Discrepancies were recorded considering primary tumor staging, the presence of muscularis propria, and the presence of histological variants. Cases were categorized as no significant discordance, major discordance without management change, and major discordance with management change according to the European Urology Association (EAU) guidelines.</p><p><strong>Key findings and limitations: </strong>Among 272 second opinion cases, 39% (108/272) had major discordance and 28% (75/272) had major discordance with change in management according to the EAU guidelines. Upstaging and downstaging were reported in 66 (24%) patients. Improper identification of the presence of muscularis propria was found in 46 (17%) cases, of which 11 (4%) were deemed clinically relevant. Differences regarding the presence of histological variants were diagnosed in 40 cases (15%), resulting in eight (3%) changes in clinical management. In ten specimens (4%), multiple clinically relevant discrepancies were found.</p><p><strong>Conclusions and clinical implications: </strong>The second opinion evaluation changed the clinical management in 25% of the cases. These results support the importance of specimen review by an expert uropathologist as a major driver in the correct bladder cancer management.</p><p><strong>Patient summary: </strong>We investigated the importance of a second opinion performed by an expert uropathologist in the management of bladder cancer. We found that 25% had their treatment plan changed due to the revised pathological report.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":"1043-1048"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467219","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 : 2024-12-01Epub Date: 2024-07-12DOI: 10.1016/j.euf.2024.07.003
Jin Kim, Chan Woo Kwak, Saangyong Uhmn, Junghoon Lee, Sangjun Yoo, Min Chul Cho, Hwancheol Son, Hyeon Jeong, Min Soo Choo
Background and objective: Our aim was to develop an artificial intelligence (AI) system for detection of urolithiasis in computed tomography (CT) images using advanced deep learning capable of real-time calculation of stone parameters such as volume and density, which are essential for treatment decisions. The performance of the system was compared to that of urologists in emergency room (ER) scenarios.
Methods: Axial CT images for patients who underwent stone surgery between August 2022 and July 2023 comprised the data set, which was divided into 70% for training, 10% for internal validation, and 20% for testing. Two urologists and an AI specialist annotated stones using Labelimg for ground-truth data. The YOLOv4 architecture was used for training, with acceleration via an RTX 4900 graphics processing unit (GPU). External validation was performed using CT images for 100 patients with suspected urolithiasis.
Key findings and limitations: The AI system was trained on 39 433 CT images, of which 9.1% were positive. The system achieved accuracy of 95%, peaking with a 1:2 positive-to-negative sample ratio. In a validation set of 5736 images (482 positive), accuracy remained at 95%. Misses (2.6%) were mainly irregular stones. False positives (3.4%) were often due to artifacts or calcifications. External validation using 100 CT images from the ER revealed accuracy of 94%; cases that were missed were mostly ureterovesical junction stones, which were not included in the training set. The AI system surpassed human specialists in speed, analyzing 150 CT images in 13 s, versus 38.6 s for evaluation by urologists and 23 h for formal reading. The AI system calculated stone volume in 0.2 s, versus 77 s for calculation by urologists.
Conclusions and clinical implications: Our AI system, which uses advanced deep learning, assists in diagnosing urolithiasis with 94% accuracy in real clinical settings and has potential for rapid diagnosis using standard consumer-grade GPUs.
Patient summary: We developed a new AI (artificial intelligence) system that can quickly and accurately detect kidney stones in CT (computed tomography) scans. Testing showed that this system is highly effective, with accuracy of 94% for real cases in the emergency department. It is much faster than traditional methods and provides rapid and reliable results to help doctors in making better treatment decisions for their patients.
{"title":"A Novel Deep Learning-based Artificial Intelligence System for Interpreting Urolithiasis in Computed Tomography.","authors":"Jin Kim, Chan Woo Kwak, Saangyong Uhmn, Junghoon Lee, Sangjun Yoo, Min Chul Cho, Hwancheol Son, Hyeon Jeong, Min Soo Choo","doi":"10.1016/j.euf.2024.07.003","DOIUrl":"10.1016/j.euf.2024.07.003","url":null,"abstract":"<p><strong>Background and objective: </strong>Our aim was to develop an artificial intelligence (AI) system for detection of urolithiasis in computed tomography (CT) images using advanced deep learning capable of real-time calculation of stone parameters such as volume and density, which are essential for treatment decisions. The performance of the system was compared to that of urologists in emergency room (ER) scenarios.</p><p><strong>Methods: </strong>Axial CT images for patients who underwent stone surgery between August 2022 and July 2023 comprised the data set, which was divided into 70% for training, 10% for internal validation, and 20% for testing. Two urologists and an AI specialist annotated stones using Labelimg for ground-truth data. The YOLOv4 architecture was used for training, with acceleration via an RTX 4900 graphics processing unit (GPU). External validation was performed using CT images for 100 patients with suspected urolithiasis.</p><p><strong>Key findings and limitations: </strong>The AI system was trained on 39 433 CT images, of which 9.1% were positive. The system achieved accuracy of 95%, peaking with a 1:2 positive-to-negative sample ratio. In a validation set of 5736 images (482 positive), accuracy remained at 95%. Misses (2.6%) were mainly irregular stones. False positives (3.4%) were often due to artifacts or calcifications. External validation using 100 CT images from the ER revealed accuracy of 94%; cases that were missed were mostly ureterovesical junction stones, which were not included in the training set. The AI system surpassed human specialists in speed, analyzing 150 CT images in 13 s, versus 38.6 s for evaluation by urologists and 23 h for formal reading. The AI system calculated stone volume in 0.2 s, versus 77 s for calculation by urologists.</p><p><strong>Conclusions and clinical implications: </strong>Our AI system, which uses advanced deep learning, assists in diagnosing urolithiasis with 94% accuracy in real clinical settings and has potential for rapid diagnosis using standard consumer-grade GPUs.</p><p><strong>Patient summary: </strong>We developed a new AI (artificial intelligence) system that can quickly and accurately detect kidney stones in CT (computed tomography) scans. Testing showed that this system is highly effective, with accuracy of 94% for real cases in the emergency department. It is much faster than traditional methods and provides rapid and reliable results to help doctors in making better treatment decisions for their patients.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":"1049-1054"},"PeriodicalIF":4.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598963","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 : 2024-11-29DOI: 10.1016/j.euf.2024.11.005
Bruno Nahar, Tarek Ajami, Adam Williams, Nachiketh Soodana Prakash, Archan Khandekar, Pedro F S Freitas, Ankur Malpani, Jonathan Rayan, Keerthana Sureshkumar, Chad R Ritch, Mark L Gonzalgo, Sanoj Punnen, Dipen J Parekh
Background and objective: Focal therapy is increasingly being used as a treatment for localized prostate cancer (PC). Our aim was to evaluate oncological outcomes, recurrence patterns, and survival after high-intensity focused ultrasound (HIFU), to discuss the lessons learned from our experience, and to propose strategies to enhance patient selection for HIFU treatment.
Methods: Between 2016 and 2023, 113 patients underwent focal HIFU treatment for PC. Follow-up included prostate-specific antigen (PSA) measurement every 3 mo, magnetic resonance imaging, and a control biopsy performed at 6 or 12 mo. Recurrence was categorized on the basis of location (infield or out-of-field) and Gleason grade group (clinically significant [CS] vs non-CS) with stratification by National Comprehensive Cancer Network risk groups. Kaplan-Meier curves were used to analyze survival outcomes, recurrence rates, and the need for retreatment.
Key findings and limitations: Median follow-up was 29 mo and 92 patients (81%) had PSA follow-up for at least 12 mo. Local recurrence was observed in 34 patients (37%), which was CS in 16 (17%). The CS recurrence-free survival rate at 3 yr was worse for subgroups with high-risk or unfavorable intermediate-risk disease in comparison to the group with favorable intermediate-risk PC (40% and 53% vs 85%; log-rank p < 0.01), with a higher rate of out-of-field recurrence in the high-risk group. The Kaplan-Meier retreatment-free survival rate estimate was 71% at 3 yr. Sixteen patients (17%) underwent salvage local treatment. Study limitations include the small cohort size and relatively short follow-up.
Conclusions and clinical implications: HIFU is a promising alternative for localized PC in well-selected patients. However, patients with high-risk or unfavorable intermediate-risk PC are more likely to experience treatment failure.
Patient summary: We examined cancer control outcomes after high-intensity focused ultrasound for localized prostate cancer. We found that the rate of cancer recurrence was higher for patients with higher-risk disease. However, this treatment is a feasible and acceptable option for patients with intermediate risk.
背景与目的:局灶性治疗越来越多地被用于治疗局限性前列腺癌(PC)。我们的目的是评估高强度聚焦超声(HIFU)后的肿瘤预后、复发模式和生存率,讨论从我们的经验中吸取的教训,并提出策略,以提高患者对HIFU治疗的选择。方法:2016年至2023年,113例PC患者行局灶HIFU治疗。随访包括每3个月进行一次前列腺特异性抗原(PSA)测量,磁共振成像,并在6或12个月进行对照活检。复发根据位置(野内或野外)和Gleason分级组(临床显著[CS] vs非CS)进行分类,并根据国家综合癌症网络风险组进行分层。Kaplan-Meier曲线用于分析生存结果、复发率和再治疗的需要。主要发现和局限性:中位随访时间为29个月,92例(81%)患者进行了至少12个月的PSA随访。34例(37%)患者出现局部复发,16例(17%)患者出现CS。高风险或不良中危疾病亚组的3年无CS复发生存率比良好中危PC组更差(40%和53% vs 85%;结论和临床意义:HIFU是一种很有希望的治疗局部PC的方法。然而,高危或不利的中危PC患者更容易出现治疗失败。患者总结:我们检查了高强度聚焦超声治疗局限性前列腺癌后的癌症控制结果。我们发现,高风险疾病患者的癌症复发率更高。然而,对于中度风险的患者,这种治疗是一种可行和可接受的选择。
{"title":"Survival Outcomes and Recurrence Patterns Following Focal High-intensity Focused Ultrasound Treatment for Localized Prostate Cancer: Insights on Patient Selection and Lessons Learned.","authors":"Bruno Nahar, Tarek Ajami, Adam Williams, Nachiketh Soodana Prakash, Archan Khandekar, Pedro F S Freitas, Ankur Malpani, Jonathan Rayan, Keerthana Sureshkumar, Chad R Ritch, Mark L Gonzalgo, Sanoj Punnen, Dipen J Parekh","doi":"10.1016/j.euf.2024.11.005","DOIUrl":"https://doi.org/10.1016/j.euf.2024.11.005","url":null,"abstract":"<p><strong>Background and objective: </strong>Focal therapy is increasingly being used as a treatment for localized prostate cancer (PC). Our aim was to evaluate oncological outcomes, recurrence patterns, and survival after high-intensity focused ultrasound (HIFU), to discuss the lessons learned from our experience, and to propose strategies to enhance patient selection for HIFU treatment.</p><p><strong>Methods: </strong>Between 2016 and 2023, 113 patients underwent focal HIFU treatment for PC. Follow-up included prostate-specific antigen (PSA) measurement every 3 mo, magnetic resonance imaging, and a control biopsy performed at 6 or 12 mo. Recurrence was categorized on the basis of location (infield or out-of-field) and Gleason grade group (clinically significant [CS] vs non-CS) with stratification by National Comprehensive Cancer Network risk groups. Kaplan-Meier curves were used to analyze survival outcomes, recurrence rates, and the need for retreatment.</p><p><strong>Key findings and limitations: </strong>Median follow-up was 29 mo and 92 patients (81%) had PSA follow-up for at least 12 mo. Local recurrence was observed in 34 patients (37%), which was CS in 16 (17%). The CS recurrence-free survival rate at 3 yr was worse for subgroups with high-risk or unfavorable intermediate-risk disease in comparison to the group with favorable intermediate-risk PC (40% and 53% vs 85%; log-rank p < 0.01), with a higher rate of out-of-field recurrence in the high-risk group. The Kaplan-Meier retreatment-free survival rate estimate was 71% at 3 yr. Sixteen patients (17%) underwent salvage local treatment. Study limitations include the small cohort size and relatively short follow-up.</p><p><strong>Conclusions and clinical implications: </strong>HIFU is a promising alternative for localized PC in well-selected patients. However, patients with high-risk or unfavorable intermediate-risk PC are more likely to experience treatment failure.</p><p><strong>Patient summary: </strong>We examined cancer control outcomes after high-intensity focused ultrasound for localized prostate cancer. We found that the rate of cancer recurrence was higher for patients with higher-risk disease. However, this treatment is a feasible and acceptable option for patients with intermediate risk.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754779","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 : 2024-11-28DOI: 10.1016/j.euf.2024.11.009
Parth Patel, Srinivas Nallandhighal, David Scoville, Brittney Cotta, Zayne Knuth, Daniel Triner, Lynn Tran, Aaron M Udager, Arvind Rao, Todd M Morgan, Ganesh S Palapattu, Vipulkumar Dadhania, Sethu Pitchiaya, Simpa S Salami
Background and objective: Prostate cancer (PC) in the transition zone (TZ) has better prognosis than peripheral-zone (PZ) PC despite higher prostate-specific antigen (PSA) in patients with TZ tumors. Our aim was to characterize molecular differences between TZ and PZ tumors and their clinical implications.
Methods: We performed spatial whole-transcriptome analyses of 50 regions of interest (ROIs) from three patients with PZ and/or TZ PC. ROIs were selected on the basis of SYTO13, pan-cytokeratin, smooth muscle actin, and CD45 markers. Downstream analyses of the transcriptomics data included differential gene expression and Molecular Signatures Database cancer hallmark analysis for pathway enrichment. Survival analyses were performed in The Cancer Genome Atlas (TCGA) prostate data set.
Key findings and limitations: We analyzed Gleason grade 4 (10 ROIs) and grade 5 (10 ROIs) tumors from the PZ, and grade 3 (10 ROIs), grade 4 (11 ROIs), and grade 5 (1 ROI) tumors from the TZ. We observed distinct gene expression profiles between PZ (n = 20) and TZ (n = 22) tumors. TZ ROIs exhibited enrichment of androgen response signaling (ARS; false discovery rate <5%) and a higher androgen subscore of the genomic prostate score (p < 0.001), regardless of grade and the epithelial, stromal, or immune component of the region. Genes underexpressed in PZ tumors, including ARS genes, were associated with poorer progression-free survival in the TCGA data set (n = 451; p < 0.05).
Conclusions and clinical implications: Our results demonstrate higher ARS in TZ tumors than in PZ tumors, explaining the higher PSA and better prognosis for TZ tumors. Further studies are needed to integrate zonal location in diagnostic and treatment algorithms for PC.
Patient summary: We looked at the biological explanation for higher PSA (prostate-specific antigen) levels in blood for cancers found in different zones of the prostate. We found that genes involved in androgen response signaling may explain the higher PSA often seen for tumors in the transition zone than for tumors in the peripheral zone of the prostate. These findings may inform how we diagnose and treat prostate cancer.
{"title":"Spatial Transcriptomic Profiling to Characterize the Nature of Peripheral- Versus Transition-zone Prostate Cancer.","authors":"Parth Patel, Srinivas Nallandhighal, David Scoville, Brittney Cotta, Zayne Knuth, Daniel Triner, Lynn Tran, Aaron M Udager, Arvind Rao, Todd M Morgan, Ganesh S Palapattu, Vipulkumar Dadhania, Sethu Pitchiaya, Simpa S Salami","doi":"10.1016/j.euf.2024.11.009","DOIUrl":"10.1016/j.euf.2024.11.009","url":null,"abstract":"<p><strong>Background and objective: </strong>Prostate cancer (PC) in the transition zone (TZ) has better prognosis than peripheral-zone (PZ) PC despite higher prostate-specific antigen (PSA) in patients with TZ tumors. Our aim was to characterize molecular differences between TZ and PZ tumors and their clinical implications.</p><p><strong>Methods: </strong>We performed spatial whole-transcriptome analyses of 50 regions of interest (ROIs) from three patients with PZ and/or TZ PC. ROIs were selected on the basis of SYTO13, pan-cytokeratin, smooth muscle actin, and CD45 markers. Downstream analyses of the transcriptomics data included differential gene expression and Molecular Signatures Database cancer hallmark analysis for pathway enrichment. Survival analyses were performed in The Cancer Genome Atlas (TCGA) prostate data set.</p><p><strong>Key findings and limitations: </strong>We analyzed Gleason grade 4 (10 ROIs) and grade 5 (10 ROIs) tumors from the PZ, and grade 3 (10 ROIs), grade 4 (11 ROIs), and grade 5 (1 ROI) tumors from the TZ. We observed distinct gene expression profiles between PZ (n = 20) and TZ (n = 22) tumors. TZ ROIs exhibited enrichment of androgen response signaling (ARS; false discovery rate <5%) and a higher androgen subscore of the genomic prostate score (p < 0.001), regardless of grade and the epithelial, stromal, or immune component of the region. Genes underexpressed in PZ tumors, including ARS genes, were associated with poorer progression-free survival in the TCGA data set (n = 451; p < 0.05).</p><p><strong>Conclusions and clinical implications: </strong>Our results demonstrate higher ARS in TZ tumors than in PZ tumors, explaining the higher PSA and better prognosis for TZ tumors. Further studies are needed to integrate zonal location in diagnostic and treatment algorithms for PC.</p><p><strong>Patient summary: </strong>We looked at the biological explanation for higher PSA (prostate-specific antigen) levels in blood for cancers found in different zones of the prostate. We found that genes involved in androgen response signaling may explain the higher PSA often seen for tumors in the transition zone than for tumors in the peripheral zone of the prostate. These findings may inform how we diagnose and treat prostate cancer.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754778","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 : 2024-11-27DOI: 10.1016/j.euf.2024.11.006
Constantinos Zamboglou, Paulina Staus, Martin Wolkewitz, Jan C Peeken, Konstantinos Ferentinos, Iosif Strouthos, Andrea Farolfi, Stefan A Koerber, Alexis Vrachimis, Simon K B Spohn, Daniel M Aebersold, Anca-Ligia Grosu, Stephanie G C Kroeze, Stefano Fanti, George Hruby, Thomas Wiegel, Louise Emmett, Stefanie Hayoz, Francesco Ceci, Matthias Guckenberger, Claus Belka, Nina-Sophie Schmidt-Hegemann, Pirus Ghadjar, Mohamed Shelan
Background and objective: Up to 50% of patients with prostate cancer experience prostate-specific antigen (PSA) relapse following primary radical prostatectomy (RP). Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is increasingly being used for staging after RP owing to its high detection rate. Our aim was to compare outcomes for patients who received salvage radiotherapy (sRT) with versus without PSMA PET guidance.
Methods: In this observational case-control study, the control group consisted of 344 patients from the SAKK09/10 trial (sRT without PSMA PET guidance from 2011 to 2014). The treatment group consisted of 1548 patients from a retrospective multicenter cohort (PSMA PET-guided sRT from July 2013 to 2020). Data were collected up to November 2023. Patients with pN1 status at RP, initial cM1 status, cM1 status on PET, or PSA >0.5 ng/ml were excluded. Patients with detectable PSA after RP who were treated with sRT were eligible. We assessed 3-yr biochemical recurrence-free survival (BRFS) and metastasis-free survival (MFS).
Key findings and limitations: The study population of 717 patients comprised a control group (n = 255) with median follow-up of 75 mo and a PSMA PET group (n = 462) with median follow-up of 31 mo. In the PSMA PET cohort, 103 patients (22.3%) had PSMA-positive pelvic lymph nodes (PLNs), 85 (18.4%) received androgen deprivation therapy (ADT), and 104 (22.5%) underwent PLN irradiation. The BRFS rate at 3 yr was 71% (95% confidence interval [CI] 64-78%) for the control group and 77% (95% CI 72-82%) for the PSMA PET group. The PSMA PET group had favorable BRFS at 18-24 mo after sRT (hazard ratio 0.32, 95% CI 0.0.14-0.75; p = 0.01) and a lower rate of lymph node relapse after sRT (standardized mean difference 0.603). The MFS rate at 3 yr was 89.2% (95% CI 84.6-94.1%) for the control group and 91.2% (95% CI 88.1-94.4%) for the PSMA PET group.
Conclusions and clinical implications: Our results suggest a moderate improvement in short-term BRFS if PSMA PET is used to guide sRT. One possible reason is individualized PLN coverage facilitated by PET. MFS was not improved by PSMA PET guidance for sRT.
Patients' summary: For patients who experience recurrence of prostate cancer after surgical removal of their prostate, salvage radiotherapy (sRT) is a further treatment option. We found that a type of scan called PSMA PET (prostate-specific membrane antigen positron emission tomography) to identify recurrence and guide sRT can improve recurrence-free survival because of better targeting of pelvic lymph nodes that may contain cancer cells.
背景和目的:高达50%的前列腺癌患者在原发性根治性前列腺切除术(RP)后出现前列腺特异性抗原(PSA)复发。前列腺特异性膜抗原(PSMA)正电子发射断层扫描(PET)因其检出率高而越来越多地用于RP后的分期。我们的目的是比较接受补救性放疗(sRT)的患者在PSMA PET指导下与不接受的结果。方法:在这项观察性病例-对照研究中,对照组包括来自SAKK09/10试验(2011 - 2014年无PSMA PET指导的sRT)的344例患者。治疗组包括来自2013年7月至2020年的回顾性多中心队列(PSMA pet引导的sRT)的1548例患者。数据收集至2023年11月。排除了RP时pN1状态、初始cM1状态、PET时cM1状态或PSA低于0.5 ng/ml的患者。接受sRT治疗的RP后可检测到PSA的患者符合条件。我们评估了3年生化无复发生存期(BRFS)和无转移生存期(MFS)。主要发现和局限性:717例患者包括对照组(n = 255),中位随访75个月,PSMA PET组(n = 462),中位随访31个月。在PSMA PET队列中,103例(22.3%)患者患有PSMA阳性盆腔淋巴结(PLN), 85例(18.4%)接受了雄激素剥夺治疗(ADT), 104例(22.5%)接受了PLN照射。对照组3年BRFS率为71%(95%置信区间[CI] 64-78%), PSMA PET组为77% (95% CI 72-82%)。PSMA PET组在sRT后18-24个月有良好的BRFS(风险比0.32,95% CI 0.0.14-0.75;p = 0.01), sRT后淋巴结复发率较低(标准化平均差值0.603)。对照组3年MFS率为89.2% (95% CI 84.6-94.1%), PSMA PET组为91.2% (95% CI 88.1-94.4%)。结论和临床意义:我们的研究结果表明,如果使用PSMA PET指导sRT,短期BRFS有中度改善。一个可能的原因是PET促进了个性化的PLN覆盖。PSMA PET指导对sRT的MFS没有改善。患者总结:对于前列腺癌手术切除后复发的患者,补救性放疗(sRT)是进一步的治疗选择。我们发现一种称为PSMA PET(前列腺特异性膜抗原正电子发射断层扫描)的扫描可以识别复发并指导sRT,因为它可以更好地靶向可能含有癌细胞的盆腔淋巴结,从而提高无复发生存率。
{"title":"Better Oncological Outcomes After Prostate-specific Membrane Antigen Positron Emission Tomography-guided Salvage Radiotherapy Following Prostatectomy.","authors":"Constantinos Zamboglou, Paulina Staus, Martin Wolkewitz, Jan C Peeken, Konstantinos Ferentinos, Iosif Strouthos, Andrea Farolfi, Stefan A Koerber, Alexis Vrachimis, Simon K B Spohn, Daniel M Aebersold, Anca-Ligia Grosu, Stephanie G C Kroeze, Stefano Fanti, George Hruby, Thomas Wiegel, Louise Emmett, Stefanie Hayoz, Francesco Ceci, Matthias Guckenberger, Claus Belka, Nina-Sophie Schmidt-Hegemann, Pirus Ghadjar, Mohamed Shelan","doi":"10.1016/j.euf.2024.11.006","DOIUrl":"https://doi.org/10.1016/j.euf.2024.11.006","url":null,"abstract":"<p><strong>Background and objective: </strong>Up to 50% of patients with prostate cancer experience prostate-specific antigen (PSA) relapse following primary radical prostatectomy (RP). Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is increasingly being used for staging after RP owing to its high detection rate. Our aim was to compare outcomes for patients who received salvage radiotherapy (sRT) with versus without PSMA PET guidance.</p><p><strong>Methods: </strong>In this observational case-control study, the control group consisted of 344 patients from the SAKK09/10 trial (sRT without PSMA PET guidance from 2011 to 2014). The treatment group consisted of 1548 patients from a retrospective multicenter cohort (PSMA PET-guided sRT from July 2013 to 2020). Data were collected up to November 2023. Patients with pN1 status at RP, initial cM1 status, cM1 status on PET, or PSA >0.5 ng/ml were excluded. Patients with detectable PSA after RP who were treated with sRT were eligible. We assessed 3-yr biochemical recurrence-free survival (BRFS) and metastasis-free survival (MFS).</p><p><strong>Key findings and limitations: </strong>The study population of 717 patients comprised a control group (n = 255) with median follow-up of 75 mo and a PSMA PET group (n = 462) with median follow-up of 31 mo. In the PSMA PET cohort, 103 patients (22.3%) had PSMA-positive pelvic lymph nodes (PLNs), 85 (18.4%) received androgen deprivation therapy (ADT), and 104 (22.5%) underwent PLN irradiation. The BRFS rate at 3 yr was 71% (95% confidence interval [CI] 64-78%) for the control group and 77% (95% CI 72-82%) for the PSMA PET group. The PSMA PET group had favorable BRFS at 18-24 mo after sRT (hazard ratio 0.32, 95% CI 0.0.14-0.75; p = 0.01) and a lower rate of lymph node relapse after sRT (standardized mean difference 0.603). The MFS rate at 3 yr was 89.2% (95% CI 84.6-94.1%) for the control group and 91.2% (95% CI 88.1-94.4%) for the PSMA PET group.</p><p><strong>Conclusions and clinical implications: </strong>Our results suggest a moderate improvement in short-term BRFS if PSMA PET is used to guide sRT. One possible reason is individualized PLN coverage facilitated by PET. MFS was not improved by PSMA PET guidance for sRT.</p><p><strong>Patients' summary: </strong>For patients who experience recurrence of prostate cancer after surgical removal of their prostate, salvage radiotherapy (sRT) is a further treatment option. We found that a type of scan called PSMA PET (prostate-specific membrane antigen positron emission tomography) to identify recurrence and guide sRT can improve recurrence-free survival because of better targeting of pelvic lymph nodes that may contain cancer cells.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750158","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 : 2024-11-21DOI: 10.1016/j.euf.2024.11.003
Akihiro Matsukawa, Takafumi Yanagisawa, Marcin Miszczyk, Mehdi Kardoust Parizi, Tamás Fazekas, Ichiro Tsuboi, Stefano Mancon, Jakob Klemm, Robert Schulz, Anna Cadenar, Ekaterina Laukhtina, Paweł Rajwa, Keiichiro Mori, Jun Miki, Takahiro Kimura, Shahrokh F Shariat
Background and objective: Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC). It is highly invasive and associated with perioperative risks, while bladder-preserving trimodality therapy (TMT) offers a less invasive alternative with preferable quality of life for selected patients. We aimed to compare oncological outcomes of TMT and RC in MIBC patients, and evaluate TMT-specific outcomes.
Methods: In December 2023, PubMed, Scopus, and Web of Science were searched for studies on MIBC patients treated with TMT. Pairwise meta-analyses were conducted to compare overall survival (OS) and cancer-specific survival (CSS) between MIBC patients treated with TMT and RC, utilizing hazard ratios (HRs). We included only matched cohort studies to minimize selection bias. TMT-specific outcomes, such as response, recurrence, and toxicity rates, were pooled separately.
Key findings and limitations: Eighty-seven studies (n = 28 218) were identified. No significant differences in OS (HR: 1.05; 95% confidence interval [CI]: 0.78-1.40) and CSS (HR: 1.05; 95% CI: 0.69-1.58) were found for TMT compared with RC. In patients treated with TMT, the complete response was achieved in 74.4% (95% CI: 69.1-79.1), the estimated rate of intravesical recurrence was 23.1% (95% CI: 19.0-27.7), and the rate of grade ≥3 acute toxicity was 11.4% (95% CI: 4.0-28.4).
Conclusions and clinical implications: The oncological outcomes of TMT were comparable with those of RC, with an acceptable toxicity profile. TMT appears as a safe and effective treatment for appropriately selected MIBC patients who want to preserve their bladder. However, evidence from high-volume controlled trials is needed.
Patient summary: Well-selected patients with nonmetastatic muscle-invasive bladder cancer can be treated with "trimodality therapy" to preserve the bladder. So far, the reported outcomes are comparable with those of radical surgery, and we found no signs of excess toxicity.
{"title":"Trimodality Therapy Versus Radical Cystectomy for Muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis of Matched Cohort Studies.","authors":"Akihiro Matsukawa, Takafumi Yanagisawa, Marcin Miszczyk, Mehdi Kardoust Parizi, Tamás Fazekas, Ichiro Tsuboi, Stefano Mancon, Jakob Klemm, Robert Schulz, Anna Cadenar, Ekaterina Laukhtina, Paweł Rajwa, Keiichiro Mori, Jun Miki, Takahiro Kimura, Shahrokh F Shariat","doi":"10.1016/j.euf.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.euf.2024.11.003","url":null,"abstract":"<p><strong>Background and objective: </strong>Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC). It is highly invasive and associated with perioperative risks, while bladder-preserving trimodality therapy (TMT) offers a less invasive alternative with preferable quality of life for selected patients. We aimed to compare oncological outcomes of TMT and RC in MIBC patients, and evaluate TMT-specific outcomes.</p><p><strong>Methods: </strong>In December 2023, PubMed, Scopus, and Web of Science were searched for studies on MIBC patients treated with TMT. Pairwise meta-analyses were conducted to compare overall survival (OS) and cancer-specific survival (CSS) between MIBC patients treated with TMT and RC, utilizing hazard ratios (HRs). We included only matched cohort studies to minimize selection bias. TMT-specific outcomes, such as response, recurrence, and toxicity rates, were pooled separately.</p><p><strong>Key findings and limitations: </strong>Eighty-seven studies (n = 28 218) were identified. No significant differences in OS (HR: 1.05; 95% confidence interval [CI]: 0.78-1.40) and CSS (HR: 1.05; 95% CI: 0.69-1.58) were found for TMT compared with RC. In patients treated with TMT, the complete response was achieved in 74.4% (95% CI: 69.1-79.1), the estimated rate of intravesical recurrence was 23.1% (95% CI: 19.0-27.7), and the rate of grade ≥3 acute toxicity was 11.4% (95% CI: 4.0-28.4).</p><p><strong>Conclusions and clinical implications: </strong>The oncological outcomes of TMT were comparable with those of RC, with an acceptable toxicity profile. TMT appears as a safe and effective treatment for appropriately selected MIBC patients who want to preserve their bladder. However, evidence from high-volume controlled trials is needed.</p><p><strong>Patient summary: </strong>Well-selected patients with nonmetastatic muscle-invasive bladder cancer can be treated with \"trimodality therapy\" to preserve the bladder. So far, the reported outcomes are comparable with those of radical surgery, and we found no signs of excess toxicity.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692844","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 : 2024-11-16DOI: 10.1016/j.euf.2024.11.001
Alireza Ghoreifi, Farshad Sheybaee Moghaddam, Anirban P Mitra, Ashish Khanna, Amitabh Singh, Julian Chavarriaga, Sol C Moon, Ahmed Saeed Goolam, Ryan Chuang, Jordan M Rich, Fady J Baky, Matthew Ho, Jacob Roberts, Inderbir S Gill, James R Porter, Nariman Ahmadi, Reza Mehrazin, John P Sfakianos, Soroush Rais-Bahrami, Aditya Bagrodia, Robert J Hamilton, Scott Eggener, Sudhir Rawal, John F Ward, Hooman Djaladat
Background and objective: The feasibility and safety of a robotic approach for postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in testicular cancer have been demonstrated, but data on long-term oncological outcomes of this procedure are limited. Our aim was to evaluate oncological outcomes following robotic PC-RPLND in this setting.
Methods: This retrospective cohort study included consecutive patients with testicular cancer treated with robotic PC-RPLND at 11 academic centers worldwide between 2011 and 2023. Patient characteristics, clinicopathological findings, and oncological outcomes were recorded. Recurrence-free survival (RFS) was estimated via the Kaplan-Meier method.
Key findings and limitations: A total of 173 patients were included, of whom 159 underwent pure robotic PC-RPLND; 14 cases were converted to open surgery. Among the pure robotic cases, 152 (96%) had nonseminoma, 122 (77%) had International Germ Cell Cancer Collaborative Group good risk, and 120 (76%) had a postchemotherapy mass size ≤5 cm. Salvage chemotherapy was received by ten patients (6%). Median estimated blood loss, operative time, and length of hospital stay were 100 ml, 300 min, and 2 d, respectively. Final pathology revealed necrosis/fibrosis in 64 cases (40%), teratoma in 78 (49%), and viable germ-cell tumor in 17 (11%). At median follow-up of 22 mo (interquartile range 7-50), eight patients had disease recurrence, which was in-field in three cases. One port-site recurrence was identified. The median time to recurrence was 7 mo. The 4-yr RFS rate was 93%. Two cancer-related deaths were recorded. Subgroup analysis revealed that patients with conversion to open surgery were more likely to have a larger preoperative mass and received salvage chemotherapy before RPLND. In addition, conversion to open surgery was associated with a higher rate of perioperative complications; however, oncological outcomes were statistically similar to those for pure robotic PC-RPLND. The main limitation of the study is its retrospective nature.
Conclusions and clinical implications: Robotic PC-RPLND in testicular cancer is associated with acceptable intermediate-term oncological outcomes in appropriately selected patients.
Patient summary: In this large multicenter study, we investigated the outcomes of robotic surgery after chemotherapy for advanced testicular cancer. We found that robotic surgery yields acceptable cancer control results.
{"title":"Oncological Outcomes Following Robotic Postchemotherapy Retroperitoneal Lymph Node Dissection for Testicular Cancer: A Worldwide Multicenter Study.","authors":"Alireza Ghoreifi, Farshad Sheybaee Moghaddam, Anirban P Mitra, Ashish Khanna, Amitabh Singh, Julian Chavarriaga, Sol C Moon, Ahmed Saeed Goolam, Ryan Chuang, Jordan M Rich, Fady J Baky, Matthew Ho, Jacob Roberts, Inderbir S Gill, James R Porter, Nariman Ahmadi, Reza Mehrazin, John P Sfakianos, Soroush Rais-Bahrami, Aditya Bagrodia, Robert J Hamilton, Scott Eggener, Sudhir Rawal, John F Ward, Hooman Djaladat","doi":"10.1016/j.euf.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.euf.2024.11.001","url":null,"abstract":"<p><strong>Background and objective: </strong>The feasibility and safety of a robotic approach for postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in testicular cancer have been demonstrated, but data on long-term oncological outcomes of this procedure are limited. Our aim was to evaluate oncological outcomes following robotic PC-RPLND in this setting.</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive patients with testicular cancer treated with robotic PC-RPLND at 11 academic centers worldwide between 2011 and 2023. Patient characteristics, clinicopathological findings, and oncological outcomes were recorded. Recurrence-free survival (RFS) was estimated via the Kaplan-Meier method.</p><p><strong>Key findings and limitations: </strong>A total of 173 patients were included, of whom 159 underwent pure robotic PC-RPLND; 14 cases were converted to open surgery. Among the pure robotic cases, 152 (96%) had nonseminoma, 122 (77%) had International Germ Cell Cancer Collaborative Group good risk, and 120 (76%) had a postchemotherapy mass size ≤5 cm. Salvage chemotherapy was received by ten patients (6%). Median estimated blood loss, operative time, and length of hospital stay were 100 ml, 300 min, and 2 d, respectively. Final pathology revealed necrosis/fibrosis in 64 cases (40%), teratoma in 78 (49%), and viable germ-cell tumor in 17 (11%). At median follow-up of 22 mo (interquartile range 7-50), eight patients had disease recurrence, which was in-field in three cases. One port-site recurrence was identified. The median time to recurrence was 7 mo. The 4-yr RFS rate was 93%. Two cancer-related deaths were recorded. Subgroup analysis revealed that patients with conversion to open surgery were more likely to have a larger preoperative mass and received salvage chemotherapy before RPLND. In addition, conversion to open surgery was associated with a higher rate of perioperative complications; however, oncological outcomes were statistically similar to those for pure robotic PC-RPLND. The main limitation of the study is its retrospective nature.</p><p><strong>Conclusions and clinical implications: </strong>Robotic PC-RPLND in testicular cancer is associated with acceptable intermediate-term oncological outcomes in appropriately selected patients.</p><p><strong>Patient summary: </strong>In this large multicenter study, we investigated the outcomes of robotic surgery after chemotherapy for advanced testicular cancer. We found that robotic surgery yields acceptable cancer control results.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647028","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 : 2024-11-13DOI: 10.1016/j.euf.2024.10.009
Christian Corsini, Daniele Robesti, Luca Villa, Francesco Montorsi, Amelia Pietropaolo, Frederic Panthier, Alba Sierra, Patrick Juliebø-Jones, Jia-Lun Kwok, Arman Tsaturyan, Pablo Contreras, Nicola Fossati, Andrea Gallina, Etienne Xavier Keller, Thomas Knoll, Ioannis Kartalas Goumas, Bhaskar K Somani, Olivier Traxer, Andrea Salonia, Eugenio Ventimiglia
Background and objective: The aim of our review was to comprehensively evaluate the impact of pulse modulation technology in the field of endourology, with a focus on laser lithotripsy and prostate enucleation.
Methods: A systematic search was conducted in the PubMed, MEDLINE, and Scopus databases for articles published during the past 20 yr (January 2004-July 2024). Article selection adhered to the Population, Intervention, Comparator, Outcome (PICO) framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In vivo, ex vivo, in vitro, and clinical studies that reported on the impact of pulse modulation technologies in laser lithotripsy or prostate enucleation in comparison to a standard references or as a standalone report, with a focus on stone ablation efficiency, safety, tissue ablation, and hemostasis, were eligible. A total of 29 articles were included.
Key findings: Pulse modulation is a feature mostly implemented for Ho:YAG laser generators. Preclinical studies on pulse modulation have demonstrated promising results for both stone fragmentation and laser-tissue interaction. Clinical studies that investigated technologies such as the Vapor Tunnel, Virtual Basket, and Moses have revealed better efficiency in comparison to the short-pulse modality. While there have been modest improvements in hemostasis and operating time, there has been no obvious improvement in outcomes after prostate surgery.
Conclusions and clinical implications: While in vitro studies have shown that pulse modulation improves stone fragmentation, reduces retropulsion, and maintains thermal safety, clinical outcomes are more variable. For prostate enucleation, the benefits are less consistent. Pulse modulation may improve efficiency, primarily by reducing operating times, but key outcomes such as stone-free and complication rates remain comparable to those with standard modalities.
Patient summary: Our review shows that pulse modulation technology improves the effectiveness and safety of laser treatments for kidney stones. However, the benefits of this technology for prostate surgery are still uncertain, highlighting the need for more research.
{"title":"Is Pulse Modulation the Future of Laser Technology in Endourology: Evidence from a Literature Review - Section of EAU Endourology.","authors":"Christian Corsini, Daniele Robesti, Luca Villa, Francesco Montorsi, Amelia Pietropaolo, Frederic Panthier, Alba Sierra, Patrick Juliebø-Jones, Jia-Lun Kwok, Arman Tsaturyan, Pablo Contreras, Nicola Fossati, Andrea Gallina, Etienne Xavier Keller, Thomas Knoll, Ioannis Kartalas Goumas, Bhaskar K Somani, Olivier Traxer, Andrea Salonia, Eugenio Ventimiglia","doi":"10.1016/j.euf.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.euf.2024.10.009","url":null,"abstract":"<p><strong>Background and objective: </strong>The aim of our review was to comprehensively evaluate the impact of pulse modulation technology in the field of endourology, with a focus on laser lithotripsy and prostate enucleation.</p><p><strong>Methods: </strong>A systematic search was conducted in the PubMed, MEDLINE, and Scopus databases for articles published during the past 20 yr (January 2004-July 2024). Article selection adhered to the Population, Intervention, Comparator, Outcome (PICO) framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In vivo, ex vivo, in vitro, and clinical studies that reported on the impact of pulse modulation technologies in laser lithotripsy or prostate enucleation in comparison to a standard references or as a standalone report, with a focus on stone ablation efficiency, safety, tissue ablation, and hemostasis, were eligible. A total of 29 articles were included.</p><p><strong>Key findings: </strong>Pulse modulation is a feature mostly implemented for Ho:YAG laser generators. Preclinical studies on pulse modulation have demonstrated promising results for both stone fragmentation and laser-tissue interaction. Clinical studies that investigated technologies such as the Vapor Tunnel, Virtual Basket, and Moses have revealed better efficiency in comparison to the short-pulse modality. While there have been modest improvements in hemostasis and operating time, there has been no obvious improvement in outcomes after prostate surgery.</p><p><strong>Conclusions and clinical implications: </strong>While in vitro studies have shown that pulse modulation improves stone fragmentation, reduces retropulsion, and maintains thermal safety, clinical outcomes are more variable. For prostate enucleation, the benefits are less consistent. Pulse modulation may improve efficiency, primarily by reducing operating times, but key outcomes such as stone-free and complication rates remain comparable to those with standard modalities.</p><p><strong>Patient summary: </strong>Our review shows that pulse modulation technology improves the effectiveness and safety of laser treatments for kidney stones. However, the benefits of this technology for prostate surgery are still uncertain, highlighting the need for more research.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617562","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}