European Urology Open Science最新文献

{"title":"Genetic Testing and Imaging in Men with Familial History or Genetic Predisposition of Prostate Cancer—Introducing the Prospective “ProFam-Risk” Study","authors":"Jale Lakes ,&nbsp;Matthias Boschheidgen ,&nbsp;Gerald Antoch ,&nbsp;Maike K. Klett ,&nbsp;André Karger ,&nbsp;Regina Roth ,&nbsp;Silke Redler ,&nbsp;Mangalore G. Pai ,&nbsp;Dagmar Wieczorek ,&nbsp;Bernadette Jäger ,&nbsp;Tanja N. Fehm ,&nbsp;Günter Niegisch ,&nbsp;Tilman T. Rau ,&nbsp;Peter Albers","doi":"10.1016/j.euros.2025.12.018","DOIUrl":"10.1016/j.euros.2025.12.018","url":null,"abstract":"<div><div>Familial and genetic factors influence prostate cancer (PCa) risk, necessitating personalized prevention strategies. This study aims to establish and validate a prevention clinic (ProFam-Risk) for men with a familial or genetic risk of PCa, focusing on genetic testing, multiparametric magnetic resonance imaging (mpMRI), and psychosocial assessment. ProFam-Risk is a prospective registry and outpatient clinic at the University Hospital Düsseldorf, recruiting participants into three groups: healthy men with a familial risk (having two or more affected relatives or early-onset PCa), men with pathogenic germline variants (eg, <em>BRCA1/2</em>), and PCa-affected men meeting familial/genetic criteria. Participants undergo prostate-specific antigen testing, mpMRI, genetic analysis, psychosocial assessment, and receive risk-adapted recommendations for cancer prevention. Outcome measures include prevalence of pathogenic variants, PCa detection rates, and the impact of genetic counseling and mpMRI on clinical decision-making.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"84 ","pages":"Pages 13-21"},"PeriodicalIF":4.5,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Implementation of INTERVAL-GAP4: A Global Randomised Controlled Trial of Intense Hybrid-supervised/Self-managed Versus Self-directed Exercise for Metastatic Prostate Cancer","authors":"Stacey A. Kenfield ,&nbsp;Nicolas H. Hart ,&nbsp;Kerry S. Courneya ,&nbsp;Rosemary Greenwood ,&nbsp;June M. Chan ,&nbsp;Jennette Sison ,&nbsp;Li Zhang ,&nbsp;Sarah Rudman ,&nbsp;Leah Ung ,&nbsp;Moritz Schumann ,&nbsp;Erin L. Van Blarigan ,&nbsp;Sam McKeown ,&nbsp;Charles J. Ryan ,&nbsp;James Catto ,&nbsp;Daniel A. Galvão ,&nbsp;Robert U. Newton ,&nbsp;Fred Saad","doi":"10.1016/j.euros.2025.12.001","DOIUrl":"10.1016/j.euros.2025.12.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objective&lt;/h3&gt;&lt;div&gt;Physical activity is associated with a lower risk of mortality in men with prostate cancer (PC); yet, randomised controlled trials with survival endpoints are nonexistent. INTense ExeRcise for surviVAL-Global Action Plan 4 (INTERVAL-GAP4) was a global phase 3 trial designed to test whether structured, hybrid-supervised/self-managed exercise improves survival in men with metastatic PC. The trial was stopped early due to poor accrual. This paper reports feasibility and implementation outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Men with metastatic PC were randomised (1:1) to a supervised/self-managed moderate- to high-intensity resistance and aerobic programme (three sessions per week for 2 yr) or to self-directed exercise. We evaluated site activation, recruitment, year 1 adherence, adverse events, and barriers to global trial feasibility. Efficacy outcomes—including survival, physical fitness, and biomarker results—will be reported separately.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key findings and limitations&lt;/h3&gt;&lt;div&gt;Of 21 activated sites across seven countries, 13 (62%) randomised patients. Of 938 patients approached, 232 (25%) consented and 145 (15%) were randomised (75 in the intervention and 70 in the control group) between April 2016 and February 2023. The median age was 70 yr (range: 44–89 yr). The study closed early after reaching 17% of the intended target. The median adherence in the intervention arm was 84% (interquartile range: 61–95%), with no difference between metastatic castrate-resistant and hormone-sensitive PC. At 12 mo, 58% of intervention participants met exercise guidelines versus 24% of controls. In year 1, 162 adverse events occurred in the intervention group and 109 in the control group; 19 adverse events were study related, all in the intervention arm. The major feasibility challenges included administrative burden, infrastructure limitations, logistics of supervised exercise delivery, and coronavirus disease 2019 disruptions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and clinical implications&lt;/h3&gt;&lt;div&gt;While high adherence to a demanding exercise programme was achieved in selected metastatic PC patients, global recruitment proved difficult. Future large-scale exercise-oncology trials require streamlined protocols, realistic timelines, and greater alignment with site resources. Implementation science research is needed to support integration of exercise into routine advanced cancer care. A forthcoming paper will present the trial’s survival and physical fitness efficacy outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient summary&lt;/h3&gt;&lt;div&gt;In this report, we describe the feasibility of a centrally coordinated, global clinical trial of hybrid-supervised/self-managed versus self-directed exercise for men with metastatic prostate cancer. We report trial implementation as mixed across the world, while exercise session adherence was high among men receiving the intervention. However, of the patients approached, 53% declined t","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"84 ","pages":"Pages 29-39"},"PeriodicalIF":4.5,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world Inter-rater Agreement of PI-QUAL Version 2 for Prostate Magnetic Resonance Imaging Quality Assessment and Its Association with Diagnostic Accuracy","authors":"Daniel L. van den Kroonenberg ,&nbsp;Jelle Barentsz ,&nbsp;Bo J. Hamstra ,&nbsp;Stijn M. van den Bosch ,&nbsp;Joris-Jan Gijsbertsen ,&nbsp;Johannes B. Reitsma ,&nbsp;Giorgio Brembilla ,&nbsp;Iztok Caglic ,&nbsp;H.P.J. Raat ,&nbsp;Maarten de Rooij ,&nbsp;Arnoud W. Postema ,&nbsp;Francesco Giganti ,&nbsp;Jorg R. Oddens","doi":"10.1016/j.euros.2025.12.019","DOIUrl":"10.1016/j.euros.2025.12.019","url":null,"abstract":"<div><h3>Background and objective</h3><div>Magnetic resonance imaging (MRI) has been shown to improve the detection of prostate cancer, the second most diagnosed cancer among men. This study evaluates the inter-rater agreement for MRI quality using Prostate Imaging Quality (PI-QUAL) v2. It studies the association of PI-QUAL with diagnostic accuracy and the proportion of indeterminate Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions with PI-QUAL scores.</div></div><div><h3>Methods</h3><div>This multicenter cohort study included biopsy-naïve patients from the PCAVISION trial (NCT06281769) who underwent MRI for a suspicion of prostate cancer. Four radiologists independently scored PI-QUAL v2 and PI-RADS. PI-QUAL v2 scores were dichotomized as PI-QUAL 1 versus PI-QUAL ≥2. PI-RADS was dichotomized as PI-RADS ≤2 versus PI-RADS ≥3 and evaluated using percentage agreement, kappa, and Gwet’s agree coefficient (AC) 1. The PI-QUAL consensus score was defined by the majority score or by a referee if no majority was reached. In cases with biopsy pathology, the association between PI-QUAL and diagnostic accuracy was assessed.</div></div><div><h3>Key findings and limitations</h3><div>In total, 352 MRI scans were included, with 150 multiparametric MRI and 202 biparametric MRI scans. The percentage agreement for dichotomized PI-QUAL was 53% (95% confidence interval [CI] 51–56%) with AC1 of 0.11 (95% CI 0.06–0.16), mainly due to one reader who strictly applied technical criteria classifying 83% as inadequate (PI-QUAL 1), compared with 12–43% by others. Exclusion of this reader resulted in a percentage agreement of 69% (95% CI 65–73%) and an AC1 of 0.51 (95% CI 0.44–0.58). Consensus classified 24% of MRI scan as PI-QUAL 1 and 76% as PI-QUAL ≥2. In an exploratory analysis, the negative predictive value was 68% (95% CI 47–85%) for PI-QUAL 1 and 74% (95% CI 60–85%) for PI-QUAL ≥2, and the positive predictive value was 62% (95% CI 45–78%) and 50% (95% CI 42–59%), respectively. The proportion of PI-RADS 3 lesions was higher in PI-QUAL 1 scans than in PI-QUAL ≥2 scans (difference of –6.5%, 95% CI –11% to –1.4%, <em>p</em> = 0.011).</div></div><div><h3>Conclusions and clinical implications</h3><div>Strict adherence to the technical PI-QUAL criteria led to poor inter-rater agreement, while visual-based assessment yielded moderate agreement. Importantly, higher PI-QUAL scores were linked to fewer indeterminate PI-RADS 3 lesions.</div></div><div><h3>Patient summary</h3><div>We studied how doctors agree when judging the quality of prostate magnetic resonance imaging (MRI) scan using the Prostate Imaging Quality scoring system. When they focused too strictly on technical rules, agreement was poor; when scans were judged visually, agreement improved. Better-quality MRI scans led to fewer unclear (“indeterminate”) results, helping doctors make clearer biopsy decisions.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"84 ","pages":"Pages 22-28"},"PeriodicalIF":4.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Socioeconomic Position, Prostate-specific Antigen, and Age with Observation in Low-risk Prostate Cancer Patients in Switzerland","authors":"Thomas Paul Scherer ,&nbsp;Dominik Menges ,&nbsp;Uwe Bieri ,&nbsp;Lea Wildisen ,&nbsp;Katharina Staehelin ,&nbsp;Florian Alexander Schmid ,&nbsp;Basil Kaufmann ,&nbsp;Daniel Eberli ,&nbsp;Sabine Rohrmann ,&nbsp;Cédric Poyet","doi":"10.1016/j.euros.2025.12.009","DOIUrl":"10.1016/j.euros.2025.12.009","url":null,"abstract":"<div><h3>Background and objective</h3><div>Observation remains the recommended management approach for low-risk prostate cancer (PCa), aiming to balance oncological control and avoidance of overtreatment. This study investigated the use of observation and its association with patients’ socioeconomic position (SEP), age, and prostate-specific antigen (PSA) level on treatment choice in Switzerland.</div></div><div><h3>Methods</h3><div>This cohort study analyzed Gleason score 6 PCa diagnoses in 2020 and 2021 from the Swiss National Agency for Cancer Registration dataset. Variables included age, PSA value, residence, and treatment codes. Municipality-based SEP deciles were linked to patients. Multivariable regression assessed the associations between SEP and observational management.</div></div><div><h3>Key findings and limitations</h3><div>Of 4296 men, 2876 (65.4%) received observational management, 792 (18.0%) underwent active treatment, and management was unknown in 728 (16.6%). Compared with men from low SEP areas, those from middle (odds ratio [OR] 1.11, 95% confidence interval [CI]: 0.92–1.35) and high SEP (OR 1.29, 95% CI: 1.06–1.58) areas had higher odds of observation. Men aged 60–70 yr (OR 1.53, 95% CI: 1.24–1.89) and &gt;70 yr (OR 2.10, 95% CI: 1.68–2.62) were more likely to undergo observation than those aged &lt;60 yr. PSA 5–10 ng/ml (OR 0.67, 95% CI: 0.55–0.82) and &gt;10 ng/ml (OR 0.60, 95% CI: 0.46–0.78) were associated with lower odds of observation compared with PSA &lt;5 ng/ml.</div></div><div><h3>Conclusions and clinical implications</h3><div>Most men diagnosed with localized low-risk PCa in Switzerland underwent observational management as the primary strategy in 2020 and 2021. However, at least 18% of men still received active treatment. Lower SEP, younger age, and higher PSA values were risk factors for active treatment within low-risk PCa patients.</div></div><div><h3>Patient summary</h3><div>We looked at how men in Switzerland with low-risk prostate cancer were treated in 2020 and 2021. We found that most men chose observation instead of immediate treatment, but men with lower socioeconomic position, younger age, or higher prostate-specific antigen levels were more likely to have active treatment. This suggests that there are opportunities to reduce unnecessary treatment for certain patient groups.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 198-204"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping of QLQ-C30 and QLQ-PR25 Scores to EQ-5D-5L Utility Values for Patients with Prostate Cancer Receiving Novel Androgen Receptor Signaling Inhibitors","authors":"Shao-Yuan Hao ,&nbsp;Shu-Pin Huang ,&nbsp;Ching-Chia Li ,&nbsp;Hung-Lung Ke ,&nbsp;Kuang-Shun Chueh ,&nbsp;Hsin-Chih Yeh ,&nbsp;Hao-Wei Chen ,&nbsp;Hsuan-Yu Hung ,&nbsp;Chung-Yu Chen ,&nbsp;Ichiro Arai","doi":"10.1016/j.euros.2025.12.005","DOIUrl":"10.1016/j.euros.2025.12.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>Disease-specific questionnaires provide detailed health insights and are increasingly used in mapping studies to estimate utility values. Given the limited mapping studies in prostate cancer, our aim was to develop mapping algorithms to convert scores from disease-specific questionnaires to EQ-5D utility values for patients receiving novel androgen receptor signaling inhibitors (ARSIs).</div></div><div><h3>Methods</h3><div>This cross-sectional study enrolled prostate cancer patients in Taiwan. Health-related quality of life was assessed using the EQ-5D-5L, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-item (QLQ-C30), and QLQ-Prostate Cancer 25-item (QLQ-PR25) instruments. Mapping algorithms were developed using ordinary least squares (OLS) and Tobit regression. Model performance was evaluated using the mean absolute error, root mean square error, Akaike information criterion, and Bayesian information criterion.</div></div><div><h3>Key findings and limitations</h3><div>A total of 100 patients were included. The mean EQ-5D index score was 0.71 (standard deviation 0.41), and the mean QLQ-C30 global health status score was 70 (standard deviation 21). Patients using an ARSI for ≥2 yr tended to report lower EQ-5D-5L index scores, global health status, and physical and social functioning, along with higher levels of fatigue, pain, and hormonal treatment–related symptoms. OLS and Tobit models demonstrated good predictive performance. However, given the small sample size, the results remain exploratory and are not intended for direct clinical use.</div></div><div><h3>Conclusions and clinical implications</h3><div>This study provides real-world evidence on the HRQoL of Asian patients with prostate cancer on ARSI therapy. The results demonstrate that QLQ-C30 data can be effectively mapped to EQ-5D-5L utility values. These findings fill a gap in knowledge left by clinical trials.</div></div><div><h3>Patient summary</h3><div>We tested whether quality of life scores reported by patients with prostate cancer who were taking a specific type of hormone therapy could be converted to values that are used in economic analyses. The results show that our mapping method can efficiently convert scores from the QLQ-C30 patient questionnaire to economic utility scores.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 219-225"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Function Outcomes in Tuberous Sclerosis Complex Patients Receiving Everolimus for Renal Angiomyolipoma","authors":"Zhangcheng Liao ,&nbsp;Wenda Wang ,&nbsp;Yang Zhao ,&nbsp;Yi Liu ,&nbsp;Dongxu Qiu ,&nbsp;Yushi Zhang","doi":"10.1016/j.euros.2025.12.013","DOIUrl":"10.1016/j.euros.2025.12.013","url":null,"abstract":"<div><h3>Background and objective</h3><div>Everolimus has been proved effective in treating renal angiomyolipoma (RAML) associated with tuberous sclerosis complex (TSC). However, its impact on renal function remains uncertain.</div></div><div><h3>Methods</h3><div>We analyzed changes in the estimated glomerular filtration rate (eGFR) in 54 TSC-RAML patients undergoing 1-yr everolimus treatment, based on the data from two previously registered clinical trials.</div></div><div><h3>Key findings and limitations</h3><div>After 1 yr of everolimus treatment, no significant change in eGFR was observed in the overall cohort of 54 patients (102 [81–121] vs 103 [79–122] ml/min/1.73 m², <em>p</em> = 0.8 for baseline vs post-treatment eGFR). Notably, patients with a tumor volume reduction (TVR) of ≥500 ml showed a significant improvement in eGFR (101 [95, 119] vs 115 [99, 122] ml/min/1.73 m², <em>p</em> = 0.009), as did those with a tumor shrinkage rate (TSR) of ≥30% (99 [80, 117] vs 104 [76, 119] ml/min/1.73 m², <em>p</em> = 0.02). Patients who experienced an eGFR improvement exhibited a significantly greater TVR (423 [86, 1035] vs 104 [28, 340] ml, <em>p</em> = 0.005) and higher TSR (40% ± 20% vs 26% ± 21%, <em>p</em> = 0.015) compared with those without improvement. Correlation analyses revealed a positive association between eGFR change and both TVR (<em>r</em> = 0.392, <em>p</em> = 0.003) and TSR (<em>r</em> = 0.430, <em>p</em> = 0.0012). In the linear mixed model, both TVR (<em>β</em> = 0.0046, <em>p</em> = 0.011) and TSR (<em>β</em> = 15.0, <em>p</em> &lt; 0.001) were independently and significantly associated with eGFR change.</div></div><div><h3>Conclusions and clinical implications</h3><div>Everolimus demonstrates a favorable renal safety profile in TSC-RAML patients and improves renal function in patients with substantial tumor reduction, supporting its use as a therapeutic option for renal function preservation.</div></div><div><h3>Patient summary</h3><div>In this study, we evaluated kidney function in patients with renal angiomyolipoma associated with tuberous sclerosis complex (TSC-RAML), who received everolimus treatment. We found that kidney function was generally stable and even improved in patients with marked tumor reduction. These results suggest that everolimus may help preserve or enhance kidney health in selected patients with TSC-RAML.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 191-197"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transperineal Versus Transrectal Prostate Biopsy: A Systematic Review and Meta-analysis of Randomized Controlled Trials Across Settings With and Without Magnetic Resonance Imaging Targeting","authors":"Yun-Jung Yang ,&nbsp;Eun-Jung Yang ,&nbsp;Tuan Thanh Nguyen ,&nbsp;Se Young Choi","doi":"10.1016/j.euros.2025.12.008","DOIUrl":"10.1016/j.euros.2025.12.008","url":null,"abstract":"<div><h3>Background and objective</h3><div>While transperineal prostate biopsy (TP-Bx) is increasingly being used to mitigate infection risk, its diagnostic equivalence to transrectal biopsy (TR-Bx) remains under investigation. Our aim was to comprehensively compare the diagnostic performance and complication profiles of TP-Bx and TR-Bx across settings with and without magnetic resonance imaging (MRI) targeting using data from randomized controlled trials (RCTs).</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis of 12 RCTs comprising 4244 patients. Outcomes included detection of clinically significant prostate cancer (csPC), anterior tumor detection, procedural pain, infection-related complications, urinary retention, and bleeding, each analyzed in groups with and without MRI targeting for biopsy.</div></div><div><h3>Key findings and limitations</h3><div>Overall csPC detection rates were comparable between TP-Bx and TR-Bx (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.95–1.39). There was no difference in MRI-targeted studies (OR 1.08, 95% CI 0.85–1.36), whereas TP-Bx showed superior csPC detection in settings without MRI targeting (OR 1.41, 95% CI 1.02–1.95). TP-Bx was associated with significantly fewer infectious complications (OR 0.70 for any infection; OR 0.35 for grade ≥3 infections), although procedural pain was higher (OR 2.05). No significant differences in urinary retention or bleeding were observed. Heterogeneity in analgesia protocols and MRI use across studies is a limitation.</div></div><div><h3>Conclusions and clinical implications</h3><div>TP-Bx and TR-Bx yield similar diagnostic performance for csPC in MRI-targeted procedures. However, in settings without MRI targeting, TP-Bx may offer better detection and a substantially lower infection risk. Although TP-Bx is associated with greater procedural discomfort, it can be performed safely under local anesthesia and without antibiotics, which aligns with antibiotic stewardship principles. These findings suggest that biopsy route selection should be individualized according to MRI availability, infection risk, and patient tolerance.</div></div><div><h3>Patient summary</h3><div>We compared evidence for two prostate biopsy methods: transperineal (TP) and transrectal (TR). Both were similar in detecting prostate cancer, but the TP method had fewer infections and may not require antibiotics. TP may cause slightly more discomfort, but pain is generally manageable with local anesthesia. Which approach is best may depend on factors such as the availability of MRI (magnetic resonance imaging), the risk of infection, and the patient’s preference.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 205-218"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PARP Inhibitor Olaparib and Its Combination Therapy in Metastatic Castration-resistant Prostate Cancer: A Systematic Review and Network Meta-analysis","authors":"Yixian Li ,&nbsp;Zongyu Li ,&nbsp;Hongxia Lu ,&nbsp;Pengjie Shi ,&nbsp;Yiting Liu ,&nbsp;Lilong Liu ,&nbsp;Ke Chen","doi":"10.1016/j.euros.2025.12.014","DOIUrl":"10.1016/j.euros.2025.12.014","url":null,"abstract":"<div><h3>Background and objective</h3><div>Olaparib is one of the earliest approved treatment options for metastatic castration-resistant prostate cancer (mCRPC). This systematic review and network meta-analysis aimed to determine the optimal olaparib strategy for treating mCRPC.</div></div><div><h3>Methods</h3><div>The Cochrane, Embase, PubMed, and Web of Science databases were searched comprehensively using “mCRPC” and “olaparib” as keywords. Study quality was appraised with the National Institutes of Health tools. Data were analyzed in R version 4.4.1. The primary endpoints included progression-free (PFS) and overall (OS) survival. The secondary endpoints included adverse events and severe adverse events (grade ≥3). Effect sizes were reported as hazard ratios (HRs) and risk ratios, with 95% credibility intervals (CrIs).</div></div><div><h3>Key findings and limitations</h3><div>Nine studies from seven clinical trials involving 2355 patients were identified. For homologous recombination repair–mutated mCRPC, combination therapies did not demonstrate significant benefits compared with olaparib alone. However, for BRCA-mutated mCRPC, olaparib combined with abiraterone improved PFS (HR = 0.61, 95% CrI = 0.41–0.91) and OS (HR = 0.41, 95% CrI = 0.21–0.80) significantly. These significant advantages of olaparib combined with abiraterone were also observed in patients from different prostate-specific antigen subgroups.</div></div><div><h3>Conclusions and clinical implications</h3><div>These findings suggest that olaparib combined with abiraterone offers substantial benefits in BRCA mutated type (BRCAmt) mCRPC patients. For those with BRCA wild type homologous recombination repair–mutated mCRPC, olaparib monotherapy is effective.</div></div><div><h3>Patient summary</h3><div>We reviewed the published studies comparing different treatment options using the drug olaparib (alone or combined with other therapies) for advanced prostate cancer that has spread and no longer responds to standard hormone therapy (metastatic castration-resistant prostate cancer). We found evidence that the effectiveness of olaparib depends significantly on specific genetic features of the cancer. For patients whose cancer has changes in the <em>BRCA</em> genes, the combination of olaparib and the drug abiraterone was more effective in delaying cancer growth and improving survival than olaparib alone. For patients with changes in other related DNA repair genes (but not <em>BRCA</em>), olaparib alone was an effective treatment. This information may assist doctors and patients in choosing the most suitable treatment based on the cancer’s genetic characteristics.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"84 ","pages":"Pages 1-12"},"PeriodicalIF":4.5,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145870068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted Buccal Mucosa Graft Ureteroplasty for Ureteral Stricture: A European Multicenter Case Series","authors":"Alice Bourillon ,&nbsp;Barry B. McGuire ,&nbsp;Ugo Pinar ,&nbsp;Ailish Naughton ,&nbsp;Thomas Tabourin ,&nbsp;Jerome Parra ,&nbsp;Christophe Vaessen ,&nbsp;Shahed Borojeni ,&nbsp;Lucas Freton ,&nbsp;Claire Richard ,&nbsp;Lee Zhao ,&nbsp;Karim Bensalah ,&nbsp;Benoît Peyronnet","doi":"10.1016/j.euros.2025.12.007","DOIUrl":"10.1016/j.euros.2025.12.007","url":null,"abstract":"<div><h3>Background and objective</h3><div>Robot-assisted buccal mucosa graft (BMG) ureteroplasty was introduced a decade ago and has since gained wide adoption within the urology community. However, available data on the outcomes of robot-assisted BMG ureteroplasty remain limited, and no large European series has been published to date. This study aims to report the outcomes of a multicenter European experience with robot-assisted BMG ureteroplasty (RBMGU) for the management of ureteral strictures.</div></div><div><h3>Methods</h3><div>Medical records of all the patients who underwent RBMGU for ureteral strictures at four European centers between 2018 and 2024 were reviewed retrospectively. The primary outcome was the absence of stricture recurrence at the last follow-up, defined as the lack of need for urinary drainage or repeat surgery, or the presence of symptomatic hydronephrosis.</div></div><div><h3>Key findings and limitations</h3><div>A total of 39 patients were included. The median stricture length was 3 cm, with 36% involving the pelvic ureter. A period of ureteral rest was implemented in 85% of patients. Early postoperative complications occurred in eight patients (21%), with only one major event (3%). After a median follow-up of 12 mo, the overall success rate was 87%. No predictive factors for recurrence were identified.</div></div><div><h3>Conclusions and clinical implications</h3><div>RBMGU for ureteral stricture appears to be a feasible and reproducible technique across multiple surgeons and institutions. The outcomes demonstrate a promising trend, with preliminary results indicating low morbidity and recurrence rates. Further studies with larger cohorts are warranted to identify the risk factors for recurrence and to better define the optimal indications for this procedure.</div></div><div><h3>Patient summary</h3><div>In this report, we present the outcomes of robotic ureteral stricture reconstruction using buccal mucosa grafts across four European centers. The results are encouraging, demonstrating low rates of stricture recurrence and postoperative complications. We emphasize the key advantages of robotic-assisted reconstruction and the broad spectrum of ureteral strictures that may benefit from this approach.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 166-172"},"PeriodicalIF":4.5,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145836776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Downregulation of ANPEP Is Associated with Aggressive Prostate Cancer and Poor Disease-specific Outcomes","authors":"Ryan M. Putney ,&nbsp;Purvish Trivedi ,&nbsp;Shivanshu Awasthi ,&nbsp;Amparo Serna ,&nbsp;Jasreman Dhillon ,&nbsp;Christopher J. Sweeney ,&nbsp;R. Jeffrey Karnes ,&nbsp;Matthew R. Cooperberg ,&nbsp;Alejandro Berlin ,&nbsp;Paul L. Nguyen ,&nbsp;Daniel E. Spratt ,&nbsp;Elai Davicioni ,&nbsp;James Proudfoot ,&nbsp;Monica Ryu ,&nbsp;Esther Katende ,&nbsp;Jong Y. Park ,&nbsp;Timothy R. Rebbeck ,&nbsp;Asmaa El-Kenawi ,&nbsp;Kosj Yamoah","doi":"10.1016/j.euros.2025.12.011","DOIUrl":"10.1016/j.euros.2025.12.011","url":null,"abstract":"<div><h3>Background and objective</h3><div>Aminopeptidase N (ANPEP) is linked to malignancy in certain tumor types, but its role in aggressive prostate cancer (PCa) is less well defined. Our aim was to characterize ANPEP expression in various PCa stages to determine whether it is a robust prognostic biomarker of aggressive disease.</div></div><div><h3>Methods</h3><div>We established baseline ANPEP expression in benign prostate tissue using multiple large databases. Next, we determined the association between ANPEP expression and various clinicopathologic features and molecular subtypes using ∼170 000 tumor samples from the GRID registry. We calculated median expression values, and reported standardized mean differences. We used receiver operating characteristic and Cox regression analyses to evaluate the diagnostic and prognostic significance of ANPEP for several endpoints, and performed preranked gene set enrichment analysis (GSEA) to identify biological pathways over-represented by race or ANPEP category according to hallmark gene sets.</div></div><div><h3>Key findings and limitations</h3><div>ANPEP expression was higher in normal prostate tissues than in prostate tumors. Advanced clinical stage, higher National Comprehensive Cancer Network risk category, and worse Gleason grade group were all associated with lower median ANPEP expression. Genomic markers of aggressive PCa, such as high Decipher scores, low androgen receptor (AR) activity, <em>ERG</em> overexpression, and loss of <em>PTEN</em> expression, were correlated with lower ANPEP expression. Among patients with locally advanced or metastatic PCa, higher ANPEP expression was significantly associated with more favorable PCa-specific outcomes, including biochemical recurrence, distant metastasis, castration-resistant PCa, and overall survival. GSEA revealed AR upregulation for the ANPEP-high group and men with genomic-derived African race. Conversely, the G₂-M DNA damage checkpoint and <em>MYC</em> target genes were enriched in the ANPEP-low and genomic-derived European race groups.</div></div><div><h3>Conclusions and clinical implications</h3><div>Our findings show that ANPEP downregulation is linked to a more aggressive PCa phenotype. Higher ANPEP levels were associated with more favorable outcomes, thereby, establishing ANPEP expression as a prognostic factor for treatment response.</div></div><div><h3>Patient summary</h3><div>We looked at levels of a protein called aminopeptidase N (ANPEP) in prostate tumors using information from large databases. We found that ANPEP is linked to markers that indicate more aggressive disease and that higher ANPEP levels are associated with more favorable treatment outcomes.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 173-184"},"PeriodicalIF":4.5,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145836769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}