European Urology Open Science最新文献

{"title":"Meta-analysis of Germline Whole-exome Sequencing in 1435 Cases of Testicular Germ Cell Tumour to Evaluate Disruptive Mutations Under Dominant, Recessive, and X-linked Inheritance Models","authors":"Zeid Kuzbari ,&nbsp;Charlie F. Rowlands ,&nbsp;Isaac Wade ,&nbsp;Alice Garrett ,&nbsp;Chey Loveday ,&nbsp;Subin Choi ,&nbsp;Beth Torr ,&nbsp;Kevin Litchfield ,&nbsp;Alison Reid ,&nbsp;Robert Huddart ,&nbsp;Peter Broderick ,&nbsp;Richard S. Houlston ,&nbsp;Clare Turnbull","doi":"10.1016/j.euros.2025.01.015","DOIUrl":"10.1016/j.euros.2025.01.015","url":null,"abstract":"<div><h3>Background and objective</h3><div>Testicular germ cell tumour (TGCT) is the most common cancer in young men, and over half of its high estimated heritability is unexplained. Our objective was to identify rare pathogenic germline variation driving TGCT susceptibility.</div></div><div><h3>Methods</h3><div>This study is a case-control meta-analysis of whole-exome sequencing data from three datasets (Institute of Cancer Research, The Cancer Genome Atlas, and UK Biobank). We retained unrelated male individuals of European ancestry comprising 1435 TGCT cases and 18 284 cancer-free controls. We performed gene-level association testing of protein-truncating variants and nonsynonymous disruptive variants across six candidate gene sets (733 genes) potentially biologically related to TGCT. We then analysed exome wide (19 355 genes) under dominant and recessive models, including X-linked genes.</div></div><div><h3>Key findings and limitations</h3><div>No individual gene-disease association was identified following multiple testing corrections. However, functional gene-set analyses identified an excess of associations with genes involved in microtubular/ciliary pathways (<em>p</em> = 1.69 × 10^–8). Our study was well powered to detect rare variation of moderate/high effect sizes (odds ratio [OR] ≥5), but power diminished for modest effect sizes (OR &lt;5).</div></div><div><h3>Conclusions and clinical implications</h3><div>Although this is the largest whole-exome analysis of TGCT to date and first exome-wide examination for recessively acting gene associations, larger studies are required to identify robust associations for individual genes.</div></div><div><h3>Patient summary</h3><div>We investigated samples from 1435 men with testicular cancer and 18 284 men without cancer to compare the rate of disruptive mutations in 19 355 genes. No evidence of specific genes associated with testicular cancer was discovered, although one gene group showed a strong association. Larger studies are needed to identify individual genes associated with causing testicular cancer.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 51-59"},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biochemical Hypogonadism in Aging Testicular Cancer Survivors: A Clinical Challenge","authors":"Sophie D. Fosså ,&nbsp;Lars J. Bjerner ,&nbsp;Torgrim Tandstad ,&nbsp;Marianne Brydøy ,&nbsp;Alv A. Dahl ,&nbsp;Ragnhild V. Nome ,&nbsp;Helene Negaard ,&nbsp;Tor Å. Myklebust ,&nbsp;Hege S. Haugnes","doi":"10.1016/j.euros.2024.12.010","DOIUrl":"10.1016/j.euros.2024.12.010","url":null,"abstract":"<div><h3>Background and objective</h3><div>Few longitudinal studies have described the prevalence and development of biochemical hypogonadism in aging testicular cancer survivors (TCSs) in comparison to men from the general population (control subjects).</div></div><div><h3>Methods</h3><div>Serum total and free testosterone (T_total, T_free) were measured in 593 TCSs median11 and 27 years after TC diagnosis (Survey-First; Survey-Last). Post-treatment adverse health outcomes (AHOs) were recorded. The results were compared to those in 578 control subjects. Treatment was stratified as surgery alone, radiotherapy alone, or platinum-based chemotherapy. Biochemical hypogonadism was defined as T_total &lt;8 nmol/l, or as T_total &lt;12 nmol/l and T_free &lt;225 pmol/l. We used multivariable logistic regression analysis to explore associations with age and treatment intensity. Statistical significance was set at <em>p</em> &lt;0.05.</div></div><div><h3>Key findings and limitations</h3><div>Between the first and last survey the prevalence of biochemical hypogonadism increased from 12% to 41% in the TSC group and from 5% to 11% in the control group. Three decades after diagnosis, the probability of biochemical hypogonadism was significantly correlated with increasing age and greater treatment intensity. The combined age- and treatment- related probability of hypogonadism was more than threefold higher in the TCS group than in the control group. At the last survey, fewer eugonadal than hypogonadal TCS men reported at least one AHO attributable to androgen deficiency (54% vs 72%; <em>p</em> &lt;0.001). Limitations include the availability of only one blood sample per survey wave.</div></div><div><h3>Conclusions and clinical implications</h3><div>For aging TCSs, the probability of biochemical hypogonadism depends on age and prior treatment intensity and is threefold higher than for control subjects at 30 yr after diagnosis. As late hypogonadism is associated with AHO incidence, the development of hypogonadism should be monitored via regular blood tests during TCS follow-up.</div></div><div><h3>Patient summary</h3><div>Depending on the treatment they received, older survivors of testicular cancer (TC) are at persistent risk of lower testosterone levels. Our study revealed low testosterone in 40% of TC survivors older than 60 years compared to 10% of similarly aged men from the general population. Low testosterone is associated with chronic conditions such as diabetes, fatigue, and/or erectile dysfunction. Testosterone should be regularly monitored during follow-up for TC survivors.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 10-16"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Evaluation of Robotic-assisted Radical Prostatectomy: A Systematic Review and Meta-analysis","authors":"Tanan Bejrananda ,&nbsp;Win Khaing ,&nbsp;Sajesh K. Veettil ,&nbsp;Therdpong Thongseiratch ,&nbsp;Nathorn Chaiyakunapruk","doi":"10.1016/j.euros.2025.01.011","DOIUrl":"10.1016/j.euros.2025.01.011","url":null,"abstract":"<div><h3>Background and objective</h3><div>Robotic-assisted radical prostatectomy (RARP) is a surgical option for localized prostate cancer. Cost-effectiveness analysis (CEA) findings are inconsistent when comparing it with open (ORP) and laparoscopic (LRP) radical prostatectomy approaches. We performed a systematic review and meta-analysis to pool the incremental net benefit (INB) of these approaches.</div></div><div><h3>Methods</h3><div>Relevant CEA studies of RARP were identified by searching the PubMed, Embase, Scopus, International Health Technology Assessment database, Tufts CEA Registry, and Centre for Reviews and Dissemination databases from January 2005 to October 2023. To be included, studies must compare costs, and quality-adjusted life years (QALYs) of RARP versus ORP or LRP, and report the incremental cost per QALY gained. Study characteristics, economic model, costs, and outcomes were extracted. INBs were calculated in 2022 US dollars adjusted for purchasing power parity. A pooled analysis was performed using a random-effect model stratified by country income level. Heterogeneity was assessed using the Q test and I² statistic.</div></div><div><h3>Key findings and limitations</h3><div>Thirteen studies with 17 comparisons, ten from high-income (HICs) and three from middle-income (MICs) countries, were included. Ten and five studies compared RARP with ORP and LRP, respectively. From a payer perspective, RARP was cost effective but not statistically significant compared with LRP in HICs (pooled INB: $7507.83 [–$1193.03 to $16 208.69], I² = 81.15%) and not cost effective in MICs (%; –$4499.39 [–$16 500 to $7526.87], I² = 17.15%). RARP showed no statistically significant cost effectiveness over ORP in both HICs ($3322.38 [–$1864.39 to $8509.15], I² = 90.89%) and MICs ($2222.60 [–$2960.64 to $7405.83], I² = 58.92%).</div></div><div><h3>Conclusions and clinical implications</h3><div>RARP is cost effective compared with LRP in HICs but lacks statistical significance. When compared with ORP, RARP is not cost effective in HICs and MICs. Our findings may support decision-making for prostate cancer treatment options in countries with different health care systems, especially those with limited resources.</div></div><div><h3>Patient summary</h3><div>Our systematic review and meta-analysis provide important information regarding robotic-assisted radical prostatectomy (RARP) compared with open (ORP) and laparoscopic (LRP) radical prostatectomy. In high-income countries, RARP is generally cost effective compared with LRP, but not with ORP, while in middle-income countries, RARP is not cost effective compared with LRP or ORP. The findings of this review can support decision-making for prostate cancer treatment options.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 17-28"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143369757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and Late Complications Associated with Penile Cancer Surgery and the Impact of Human Papillomavirus Status: Findings from a Retrospective Norwegian Cohort Study","authors":"Patrick Juliebø-Jones ,&nbsp;Ida M. Nordanger ,&nbsp;Christian Beisland ,&nbsp;Tor K. Thorkelsen ,&nbsp;Alfred Honoré ,&nbsp;Christian A. Moen","doi":"10.1016/j.euros.2025.01.009","DOIUrl":"10.1016/j.euros.2025.01.009","url":null,"abstract":"<div><h3>Background and objective</h3><div>Penile cancer (PeCa) and penile intraepithelial neoplasia (PeIN) are rare diseases, and the burden of complications associated with surgery remains under-reported. The objective was to evaluate the early (≤30 d) and late (&gt;30 d) complications and the impact of human papillomavirus (HPV) status.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted of a cohort consisting of 201 consecutive and treatment-naïve patients with PeCa/PeIN undergoing surgery (penile sparing, and partial and total amputation) between January 1, 2000 and December 31, 2023 at a tertiary centre as part of a centralised regional service.</div></div><div><h3>Key findings and limitations</h3><div>The median follow-up time was 39 (interquartile range 21, 76) mo. The early and late patient complication rates were 45% and 38%, respectively. Of the patients, 18.5% experienced two or more early complications. A majority (80%) of early complications were minor (Clavien-Dindo ≤2). There was a 1% admission rate to the intensive care unit, but no deaths were recorded within 30 d. Body mass index (BMI)was a significant predictor of early complications (<em>p</em> = 0.01). Late complications included chronic wound irritation (10%) and urethral stricture (11%). The latter was highest among those who had undergone partial amputation. One in four patients underwent reoperation due to recurrence during follow-up. HPV status had no association with the rate of either early or late complications.</div></div><div><h3>Conclusions and clinical implications</h3><div>PeCa surgery is associated with a relatively high complication burden, in both the early and the late postoperative period. Lymph node surgery further adds to the morbidity profile. BMI was a significant predictor of having an early complication, while HPV status did not affect the rate of early or late complications.</div></div><div><h3>Patient summary</h3><div>Penile cancer surgery is associated with a high rate of complications in early as well as late postoperative period. However, most of these complications are not severe. Body mass index was a significant predictor of an early complication, but human papillomavirus status was not associated with the risk of complications.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 29-35"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143369758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confirmatory Biopsy Outcomes in Patients with Grade Group 2 Prostate Cancer: Implications for Early Management","authors":"Riccardo Leni ,&nbsp;Emily A. Vertosick ,&nbsp;Nicole Liso ,&nbsp;Oguz Akin ,&nbsp;Sigrid V. Carlsson ,&nbsp;Francesco Montorsi ,&nbsp;Alberto Briganti ,&nbsp;James A. Eastham ,&nbsp;Samson W. Fine ,&nbsp;Andrew J. Vickers ,&nbsp;Behfar Ehdaie","doi":"10.1016/j.euros.2025.01.012","DOIUrl":"10.1016/j.euros.2025.01.012","url":null,"abstract":"<div><h3>Background and objective</h3><div>Guideline recommendations regarding early management of grade group (GG) 2 prostate cancer with confirmatory biopsy (cBx) are not well established. Our aim was to determine which patients with GG 2 cancer should undergo cBx before treatment decision-making by evaluating the probability of downgrading to GG 1 or no cancer on cBx.</div></div><div><h3>Methods</h3><div>This was a single-institution retrospective analysis of patients with GG 2 prostate cancer who underwent cBx. We modeled the probability of having no Gleason pattern 4 on cBx according to magnetic resonance imaging (MRI) Prostate Imaging-Reporting and Data System (PI-RADS) score, presence of extraprostatic extension (EPE) on MRI, total length of pattern 4 across all cores on initial Bx, and prostate-specific antigen (PSA) density.</div></div><div><h3>Key findings and limitations</h3><div>Among 301 patients, 62 (21%) were downgraded to GG 1 and 23 (8%) had no cancer on cBx. For patients with nonsuspicious MRI findings (PI-RADS 1–3; <em>n</em> = 123), the probability of having no pattern 4 on CBx was 34%, 20%, and 11% for 1, 2, and 3 mm of pattern 4 at initial Bx. For PI-RADS 4–5 without EPE on MRI (<em>n</em> = 146), the corresponding probabilities were 18%, 10%, and 5%. Patients with EPE on MRI (<em>n</em> = 32) had low probability (&lt;10%) of having no pattern 4 on cBx irrespective of pattern 4 on initial Bx. Results using a model based on PSA density followed a similar trend. After applying the model in a cohort of patients with GG 2 cancer who immediately underwent surgery (<em>n</em> = 2275), we estimated that two-thirds would be eligible for cBx before treatment using a probability threshold of 5–10% for avoiding immediate surgery.</div></div><div><h3>Conclusions and clinical implications</h3><div>Patients with GG 2 prostate cancer, no evidence of EPE, and a few millimeters of pattern 4 should undergo cBx before proceeding to surgery. Further research should define the oncologic risk for such patients, refine the criteria for cBx in GG 2 disease, and assess methods for quantifying pattern 4 length in MRI-targeted cores.</div></div><div><h3>Patient summary</h3><div>For patients with grade group (GG) 2 prostate cancer, we found that the amount of Gleason pattern 4 cancer in the initial biopsy, PSA (prostate-specific antigen) density, and MRI (magnetic resonance imaging) findings help to identify men who are likely to be downgraded to less aggressive GG 1 cancer or no cancer at all on a repeat confirmatory biopsy. We assessed these predictors in a group of patients with similar characteristics who underwent immediate surgery, and found that approximately two-thirds would benefit from a confirmatory biopsy.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 46-53"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Focal Therapy to Lesions Detected via Magnetic Resonance Imaging: Delivering Cancer Ablation Beyond the Visibility Phenomenon","authors":"Clement Orczyk ,&nbsp;Teresa Marsden ,&nbsp;Francesco Giganti ,&nbsp;Joseph M. Norris ,&nbsp;Santosh Waigankar ,&nbsp;Louise Dickinson ,&nbsp;Shonit Punwani ,&nbsp;Alex Kirkham ,&nbsp;Alex Freeman ,&nbsp;Aiman Haider ,&nbsp;Caroline M. Moore ,&nbsp;Arnauld Villers ,&nbsp;Clare Allen ,&nbsp;Mark Emberton","doi":"10.1016/j.euros.2025.01.010","DOIUrl":"10.1016/j.euros.2025.01.010","url":null,"abstract":"<div><div>The inclusion of imaging as a triage test in diagnostic guidelines for prostate cancer (PC) has introduced a visible target for guiding treatment allocation and disease management. Focal therapy (FT) is a promising approach with a low side-effect profile for treating magnetic resonance imaging (MRI)-visible PC within a limited framework of guideline recommendations or clinical trials. On the basis of accumulated clinical and research experience, we present a systematic approach to FT indications for ablation of visible targets that includes imaging findings, margin delineation, and energy selection. Confirmation of eligibility for FT is associated with the choice of energy source. We propose a 10-step framework that incorporates the contribution of all MRI sequences, the cancer growth pattern within the zonal anatomy to establish a margin around the MRI-visible lesion, safeguards for critical anatomic structures, and guidance for energy selection on the basis of specific properties. We discuss the key principles underlying this process. The aim of this methodology is to standardise FT interventions for MRI-visible PC and contribute to the development of a reproducible, stable treatment protocol. Quality control of the ablation procedure is crucial for broadening access to this technique beyond the confines of current regulatory pathways.</div></div><div><h3>Patient summary</h3><div>We propose a method for using results from magnetic resonance imaging (MRI) scans to guide targeted treatment of visible prostate cancer lesions. This will help to ensure accurate coverage and eradication of all of the cancer while minimising side effects.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 36-41"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk of Thromboembolic and Cardiovascular Adverse Events with PARP Inhibitor Treatment in Patients with Metastatic Castration-resistant Prostate Cancer: A Systematic Review and Safety Meta-analysis","authors":"Brigida Anna Maiorano ,&nbsp;Martina Catalano ,&nbsp;Chiara Mercinelli ,&nbsp;Antonio Cigliola ,&nbsp;Valentina Tateo ,&nbsp;Neeraj Agarwal ,&nbsp;Shilpa Gupta ,&nbsp;Giandomenico Roviello ,&nbsp;Andrea Necchi","doi":"10.1016/j.euros.2024.12.008","DOIUrl":"10.1016/j.euros.2024.12.008","url":null,"abstract":"<div><h3>Background and objective</h3><div>PARP inhibitor (PARPi) treatment is an effective option for patients with metastatic castration-resistant prostate cancer (mCRPC). There are few data on the cardiovascular and thromboembolic safety of these agents in mCRPC, as cardiovascular and thromboembolic adverse events (AEs) are uncommon. Our aim was to analyze the incidence and risk of major adverse cardiovascular events (MACEs), thromboembolic events, and hypertension with PARPi therapy in mCRPC.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We systematically searched the PubMed, EMBASE, and Cochrane databases and the American Society of Clinical Oncology and European Society of Medical Oncology meeting abstracts for clinical trials on PARPi use in mCRPC up to March 31, 2024. We analyzed the pooled incidence of all-grade and high-grade MACEs, thromboembolic events, and hypertension, and calculated risk ratios (RRs) for PARPi versus non-PARPi treatment.</div></div><div><h3>Key findings and limitations</h3><div>We included 11 phase 2 or 3 trials in our meta-analysis. Hypertension was the most common AE for both any-grade (17.2%) and high-grade (9.3%) events. In comparison to other treatments, PARPi was associated with significantly higher risk of high-grade MACEs (RR 2.03; <em>p</em> = 0.03) and thromboembolic events (RR 2.15; <em>p</em> = 0.002), especially venous thromboembolism (VTE; RR 2.13; <em>p</em> = 0.004) and pulmonary embolism (RR 3.60; <em>p</em> = 0.001). The risk of hypertension, any-grade MACEs, and thromboembolic AEs was not significantly higher, apart from VTE (RR 2.17; <em>p</em> = 0.01).</div></div><div><h3>Conclusions and clinical implications</h3><div>There is higher risk of high-grade cardiovascular and thromboembolic toxicity with PARPi use in comparison to other treatments in mCRPC, although these toxicities are rare. Clinicians should be aware of this risk, especially in a population that often has comorbidities and concomitant treatments, for correct monitoring and management of these AEs.</div></div><div><h3>Patient summary</h3><div>Drugs called PARP inhibitors are very effective in the treatment of metastatic prostate cancer that does not respond to hormone treatment. However, their use is associated with some cardiovascular adverse events, although these are rare. Our study shows that these events seem to be more frequent with PARP inhibitors than with other treatments, especially for severe grades. Doctors and patients should be aware of this risk to help in preventing, recognizing, and managing the occurrence of these rare complications.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 1-9"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunotherapy in metastatic renal cell carcinoma: Insights from a Dutch nationwide cohort","authors":"Hilin Yildirim ,&nbsp;Anke Richters ,&nbsp;Adriaan D. Bins ,&nbsp;Arnoud W. Postema ,&nbsp;Maureen J.B. Aarts ,&nbsp;Martijn G.H. van Oijen ,&nbsp;Patricia J. Zondervan ,&nbsp;Katja K.H. Aben","doi":"10.1016/j.euros.2025.01.008","DOIUrl":"10.1016/j.euros.2025.01.008","url":null,"abstract":"<div><div>Targeted therapy with tyrosine kinase inhibitors (TKIs) was the standard of care for metastatic renal cell carcinoma (mRCC) until recently, when new first-line combinations with immuno-oncology (IO) agents were approved. We evaluated IO uptake in both first-line and later-line treatment in routine clinical practice in the Netherlands. Patients diagnosed with synchronous mRCC between 2018 and 2022 were identified from the population-based Netherlands Cancer Registry (<em>n</em> = 2621). The median age was 70 yr and 58% of patients had clear-cell RCC. Overall, 55% received at least one line of systemic therapy, 7% underwent cytoreductive nephrectomy without systemic therapy, and the remaining 37% received best supportive care. In the systemic treatment cohort, first-line TKI use decreased from 94% in 2018 to 21% in 2022, while IO use increased from 6% to 79%. Data from 2019–2020 show that 32% and 10% of patients received any second-line and third-line therapy, respectively. The 3-yr overall survival rate for patients with synchronous mRCC increased from 20% (95% confidence interval [CI] 16–23%) in 2018 to 28% in 2021 (95% CI 24–33%). Our analysis shows that IO approvals for mRCC since 2019 have led to an immediate and large increase in IO use to approximately 80% of patients who receive systemic treatment.</div></div><div><h3>Patient summary</h3><div>Since 2019, systemic treatments for metastatic kidney cancer have shifted from drugs targeting selected proteins to immunotherapy. Our results show trends over time for more favorable characteristics among patients receiving systemic treatment and improvements in survival.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Pages 42-45"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrarenal Pressure Monitoring During Ureteroscopy: A Delphi Panel Consensus","authors":"Bhaskar Somani ,&nbsp;Niall Davis ,&nbsp;Esteban Emiliani ,&nbsp;Mehmet Ilker Göcke ,&nbsp;Helene Jung ,&nbsp;Etienne Xavier Keller ,&nbsp;Arkadiusz Miernik ,&nbsp;Silvia Proietti ,&nbsp;Ben Turney ,&nbsp;Oliver Wiseman ,&nbsp;Antonia Bosworth Smith ,&nbsp;Marco Caterino ,&nbsp;Rhodri Saunders ,&nbsp;Mohammed Boulmani ,&nbsp;Olivier Traxer","doi":"10.1016/j.euros.2025.01.005","DOIUrl":"10.1016/j.euros.2025.01.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>Elevated intrarenal pressure (IRP) may increase the risk of complications in patients undergoing ureteroscopy. As there is limited clarity on a threshold value for high IRP, how to manage high IRP, or which patients are at greater risk of complications due to high IRP, we used the Delphi methodology to understand expert opinion in this area.</div></div><div><h3>Methods</h3><div>The Delphi process comprised two online surveys and an in-person meeting. During the in-person meeting, areas of disagreement and consensus were explored. Consensus statements were developed and voted on to determine the level of consensus. The study was granted a waiver by HML IRB Research and Ethics (reference number 2193).</div></div><div><h3>Key findings and limitations</h3><div>The pan-European panel started with 12 and ended with 11 experienced endourologists. Eleven consensus statements were developed. The statements cover topics such as the definition of high IRP, complications linked to high IRP, and patient risk factors for these complications. After anonymous voting, consensus was achieved for all the statements. Two had a strong level and nine had a moderate level of agreement. There was no consensus on an IRP threshold, although the majority would be concerned for patient safety at a pressure above 61–80 cm H₂O.</div></div><div><h3>Conclusions and clinical implications</h3><div>Any IRP above normal physiological levels should be considered high. High IRP during ureteroscopy is a concern for patient safety. It is important to understand links between high IRP, patient characteristics, and complications. We call for additional research to better understand these risks and to inform refinements to clinical practice.</div></div><div><h3>Patient summary</h3><div>A group of experts were asked their opinion on pressure within the kidney (intrarenal pressure, IRP) during a procedure called ureteroscopy (URS), when a narrow telescope is passed through the bladder and into the tube connected to the kidney. Statements that the panel agreed on were developed. These statements show that there is a concern about high IRP during URS as it may be linked to a higher risk of complications for the patient. More research is needed to better understand high IRP and its link to patient outcomes.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 43-50"},"PeriodicalIF":3.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Management, and Prevention of Gynecomastia and Breast Pain in Patients with Prostate Cancer Undergoing Antiandrogen Therapy: A Systematic Review and Meta-analysis of Randomized Controlled Trials","authors":"Ichiro Tsuboi ,&nbsp;Robert J. Schulz ,&nbsp;Ekaterina Laukhtina ,&nbsp;Koichiro Wada ,&nbsp;Pierre I. Karakiewicz ,&nbsp;Motoo Araki ,&nbsp;Shahrokh F. Shariat","doi":"10.1016/j.euros.2025.01.001","DOIUrl":"10.1016/j.euros.2025.01.001","url":null,"abstract":"<div><h3>Background and objective</h3><div>In patients with prostate cancer treated with antiandrogen monotherapy, gynecomastia and breast pain are relatively common. In the setting of androgen receptor pathway inhibitors (ARPIs), the incidence of these adverse events (AEs) remains unclear. In addition, the effect of prophylactic treatment on gynecomastia remains uncertain. We aimed to evaluate the incidence of gynecomastia and breast pain in prostate cancer patients treated with ARPIs compared with androgen deprivation therapy (ADT) and the effect of prophylactic treatment for these AEs due to antiandrogen therapy.</div></div><div><h3>Methods</h3><div>In June 2024, we queried four databases—PubMed, Scopus, Web of Science, and Embase—for randomized controlled trials (RCTs) investigating prostate cancer treatments involving antiandrogen therapy. The endpoints of interest were the incidence of these AEs due to ARPIs and the effect of prophylactic treatment for these.</div></div><div><h3>Key findings and limitations</h3><div>Eighteen RCTs, comprising 5036 patients, were included in the systematic review and meta-analysis. ARPIs included enzalutamide, darolutamide, and apalutamide. The results indicated that patients who received ARPI monotherapy had a significantly higher incidence of gynecomastia than those who received ADT monotherapy (risk ratio [RR]: 5.19, 95% confidence interval [CI]: 3.58–7.51, <em>p</em> &lt; 0.001). There was no significant difference in the incidence of gynecomastia between ARPI plus ADT therapy and ADT monotherapy (RR: 1.27, 95% CI: 0.84–1.93, <em>p</em> = 0.2). Prophylactic tamoxifen or radiotherapy reduced significantly the incidence of gynecomastia and breast pain caused by bicalutamide monotherapy.</div></div><div><h3>Conclusions and clinical implications</h3><div>We found that ARPI monotherapy increases the incidence of these AEs significantly compared with ADT. In contrast, ARPI plus ADT therapy did not result in a higher incidence of AEs. The use of either tamoxifen or radiotherapy was effective in reducing the incidence of these AEs due to bicalutamide monotherapy. These prophylactic treatments could reduce the incidence of AEs due to ARPI monotherapy. However, further studies are needed to clarify their efficacy.</div></div><div><h3>Patient summary</h3><div>Although androgen deprivation therapy (ADT) improves overall survival in patients with prostate cancer, it is associated with several complications. Androgen receptor pathway inhibitor (ARPI) monotherapy has emerged as a promising strategy for improving oncological outcomes in these patients. However, ARPI monotherapy increases gynecomastia and breast pain in prostate cancer patients compared with ADT, while ARPI plus ADT did not result in a higher incidence of adverse events.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 31-42"},"PeriodicalIF":3.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}