European Urology Open Science最新文献

{"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":"Copyright page","authors":"","doi":"10.1016/S2666-1683(25)00068-0","DOIUrl":"10.1016/S2666-1683(25)00068-0","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"72 ","pages":"Page I"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453239","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}

{"title":"Molecular Subtyping for Predicting Pathological Upstaging and Survival Outcomes in Clinically Organ-confined Bladder Cancer Patients Undergoing Radical Cystectomy","authors":"Joep J. de Jong ,&nbsp;James A. Proudfoot ,&nbsp;Siamak Daneshmand ,&nbsp;Robert S. Svatek ,&nbsp;Vikram Narayan ,&nbsp;Elai Davicioni ,&nbsp;Shreyas Joshi ,&nbsp;Aaron Dahmen ,&nbsp;Roger Li ,&nbsp;Brant A. Inman ,&nbsp;Paras Shah ,&nbsp;Iftach Chaplin ,&nbsp;Jonathan Wright ,&nbsp;Ewan A. Gibb ,&nbsp;Yair Lotan","doi":"10.1016/j.euros.2024.12.009","DOIUrl":"10.1016/j.euros.2024.12.009","url":null,"abstract":"<div><h3>Background and objective</h3><div>Many patients with bladder cancer are understaged. Previous work revealed that molecular subtyping using Decipher Bladder improves clinical staging. This multicenter validation study evaluated Decipher Bladder for upstaging in patients who underwent radical cystectomy (RC) without neoadjuvant therapy.</div></div><div><h3>Methods</h3><div>The Decipher Bladder genomic subtyping classifier (GSC; Veracyte, San Diego, CA, USA) was performed on bladder tumor specimens from patients with high-grade, clinically organ-confined (cTa-T2N0M0) urothelial carcinoma who subsequently underwent RC without neoadjuvant chemotherapy. The primary endpoint was pathological upstaging to non–organ-confined (NOC) disease (pT3+ and/or N+) at RC. The secondary endpoints included overall survival (OS) and pathological upstaging to MIBC+ disease (pT2+ and/or N+) at RC within clinically non–muscle-invasive bladder cancer (cNMIBC) cases.</div></div><div><h3>Key findings and limitations</h3><div>A total of 226 patients (134 cNMIBC [cTa/Tis/T1] and 92 cT2) were analyzed from eight participating institutions. Upstaging to NOC disease was observed in 33% of patients (19% for cNMIBC and 53% for cT2). Molecular subtyping identified 138 luminal and 88 nonluminal tumors. Rates of upstaging to NOC were 41% in nonluminal and 28% in luminal tumors (univariable <em>p</em> = 0.04), which was not independently significant after adjusting for clinical variables. Upstaging to MIBC+ in cNMIBC patients was lower in luminal versus nonluminal tumors (32% vs 51%, multivariable <em>p</em> = 0.03). Patients with nonluminal tumors had worse OS on multivariable analyses (<em>p</em> &lt; 0.05). Limitations include retrospective design and sample size.</div></div><div><h3>Conclusions and clinical implications</h3><div>Luminal tumors represent less aggressive disease, reflected by lower rates of pathological upstaging and favorable OS with RC compared with nonluminal tumors.</div></div><div><h3>Patient summary</h3><div>Molecular subtyping suggests that in clinically non–muscle-invasive bladder cancer, luminal tumors harbor less aggressive disease, as reflected by lower rates of pathological upstaging to muscle-invasive disease and favorable outcomes with radical cystectomy, in comparison with nonluminal bladder cancer.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 24-30"},"PeriodicalIF":3.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156577","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":"Association between Two Cardiovascular Health Algorithms and Kidney Stones: A Nationwide Cross-sectional Study","authors":"Shan Yin ,&nbsp;Zhenzhen Yang ,&nbsp;Pingyu Zhu ,&nbsp;Xuesong Yang ,&nbsp;Xiaodong Yu ,&nbsp;Tielong Tang ,&nbsp;Yan Borné","doi":"10.1016/j.euros.2025.01.003","DOIUrl":"10.1016/j.euros.2025.01.003","url":null,"abstract":"<div><h3>Background and objective</h3><div>There is limited literature on the relationship between cardiovascular health (CVH) and kidney stones. This study aims to compare the association of Life’s Simple 7 (LS7) and Life’s Essential 8 (LE8) with kidney stone prevalence.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis was conducted utilizing NHANES data (2007–2018). Participants aged ≥20 yr with a history of kidney stones and available LS7 and LE8 scores were included. Both LS7 and LE8 are scored such that higher scores indicate better CVH. Weighted proportions and multivariable logistic regression models assessed the relationship between CVH metrics and kidney stone prevalence, adjusting for confounders. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were determined to distinguish between LS7 and LE8 in terms of their discriminative ability within the model associated with kidney stones.</div></div><div><h3>Key findings and limitations</h3><div>A total of 23 563 adults were included; the mean age was 48.1 yr (48.1% male). Kidney stone prevalence was 10.1%. The mean LS7 and LE8 scores were 8.4 and 68.6, respectively. A multivariate analysis and the restricted cubic spline model indicated a significant nonlinear negative correlation between these CVH measures and kidney stone prevalence. The LS7 ideal group showed a lower prevalence than the poor group (odds ratio [OR] = 0.53; 95% confidence interval [CI] 0.41–0.69). The high CVH group had a lower prevalence than the low CVH group (OR = 0.46; 95% CI 0.36–0.57). The AUCs for evaluating LS7 and kidney stones, as well as for LE8 and kidney stones were 0.676 and 0.677, respectively. Limitations were as follows: cross-sectional design limiting causal inference, recall bias from self-reported data, and potential residual confounding.</div></div><div><h3>Conclusions and clinical implications</h3><div>Both CVH algorithms show a significant nonlinear negative correlation with kidney stone prevalence. LS7 may be more accessible for broader implementation. Further high-quality prospective studies are needed to clarify this relationship.</div></div><div><h3>Patient summary</h3><div>In this study, we explored the connection between heart health and kidney stones using data from a large national survey. We found that better heart health, measured by two different scoring methods, is linked to a lower chance of having kidney stones. Our results suggest that promoting heart health could help reduce the risk of kidney stones in adults.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 8-16"},"PeriodicalIF":3.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156576","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":"Omission of Contralateral Systematic Biopsies in Unilateral Suspicious Prostate Cancer on Magnetic Resonance Imaging: Implications for Radiation Treatment Selection","authors":"Daniël L. van den Kroonenberg ,&nbsp;Sanne J. Jonker ,&nbsp;Auke Jager ,&nbsp;Joëlle D. Stoter ,&nbsp;Eva Schaake ,&nbsp;Karel A. Hinnen ,&nbsp;Wietse S.C. Eppinga ,&nbsp;Ivo G. Schoots ,&nbsp;Jochem R.N. van der Voort van Zyp ,&nbsp;André N. Vis","doi":"10.1016/j.euros.2025.01.006","DOIUrl":"10.1016/j.euros.2025.01.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>A combined approach of magnetic resonance imaging (MRI) targeted biopsies (TBx) and systematic biopsies (SBx) was recommended previously in patients with unilateral suspicious prostate cancer (PCa) on MRI. Yet, new PCa guidelines suggest that contralateral SBx can be omitted. It is unknown how this guideline modification impacts treatment selection. This study evaluates the value of contralateral SBx in radiation treatment selection in patients with unilateral suspicious lesions (Prostate Imaging Reporting and Data System [PI-RADS] ≥3) on MRI.</div></div><div><h3>Methods</h3><div>Case files of 80 patients with a unilateral suspicious lesion on diagnostic MRI who underwent TBx and bilateral SBx were collected. The cases were presented to four radiation oncologists twice: once with diagnostic information of bilateral SBx and TBx, and once with diagnostic information of ipsilateral SBx and TBx pathology results. Based on this information, external beam radiation treatment (EBRT) fractionation scheme, duration of androgen deprivation therapy (ADT), and feasibility of brachytherapy (monotherapy or brachyboost) were considered.</div></div><div><h3>Key findings and limitations</h3><div>After omitting information of contralateral SBx pathology results, selection of EBRT fractionation scheme and ADT duration changed in 14% (95% confidence interval [CI] 9.8–17) and 15% (95% CI 11–19) of cases, respectively. The feasibility of brachytherapy as monotherapy and brachyboost, respectively, changed in 11% (95% CI 7.9–15) and in 21% (95% CI 17–26) of cases, with overall poor interobserver variability for both diagnostic scenarios (Fleiss’ kappa 0.15 and 0.16).</div></div><div><h3>Conclusions and clinical implications</h3><div>Our findings indicate that omitting contralateral SBx has an impact on the treatment selection of patients who choose for radiation therapy as their treatment for locally confined PCa.</div></div><div><h3>Patient summary</h3><div>In patients with prostate cancer identified via magnetic resonance imaging on one side of the prostate, exclusion of prostate biopsies from the opposite side affected the selection of radiation treatment.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 17-23"},"PeriodicalIF":3.2,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156578","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}