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Anatomic Factors Associated with Complications After Radical Prostatectomy: A Systematic Review and Meta-analysis. 与根治性前列腺切除术后并发症相关的解剖因素:系统回顾与元分析》。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-18 DOI: 10.1016/j.euo.2024.10.018
Arthur Peyrottes, Charles Dariane, Michael Baboudjian, Eric Barret, Laurent Brureau, Gaelle Fiard, Gaelle Fromont, Romain Mathieu, Jonathan Olivier, Raphaëlle Renard-Penna, Guilhem Roubaud, Morgan Rouprêt, Paul Sargos, Stéphane Supiot, Alexandre de la Taille, Léa Turpin, François Desgrandchamps, Guillaume Ploussard, Alexandra Masson-Lecomte

Background and objective: The role of anatomical factors in predicting outcomes after radical prostatectomy (RP) remains unclear. This review aims to evaluate the impact of various anatomical factors on the perioperative outcomes of patients undergoing RP for localized prostate cancer (PCa).

Methods: A comprehensive literature search was conducted through January 2024 using the PubMed/Medline, Embase, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. Data were extracted and pooled for a meta-analysis, with outcomes including operative time, blood loss, transfusion rates, overall complications, and positive surgical margins (PSMs). Heterogeneity was assessed using Cochrane Q test, and subgroup analyses were conducted to explore the influence of surgical approach.

Key findings and limitations: A total of 91 studies met our inclusion criteria. Among the anatomical factors, prostate volume (PV), prostate weight, and median lobe (ML) were suitable for the meta-analysis. Larger prostates were associated with increased operative time, blood loss, and complication rates, but with fewer PSMs (all p < 0.05). ML presence was not associated with a higher risk of complications. Heterogeneity was high across studies (Cochrane Q tests <0.05), reflecting inconsistent definitions and methods. In subgroup analyses, the open approach was associated with a longer operative time than robotic surgery for large prostates (p = 0.03) and a lower PSM rate (p < 0.001).

Conclusions and clinical implications: Anatomical factors, particularly PV, play a significant role in RP outcomes. Larger prostates are associated with higher complication rates but fewer PSMs. Further research with standardized outcome measures is necessary to clarify these relationships and guide clinical decision-making.

Patient summary: In this study, we examined how a patient's individual anatomy might affect the results of prostate surgery for cancer. We found that larger prostates tend to lead to longer surgeries and increased blood loss, but these also have a lower risk of leaving cancer cells behind. These findings could help doctors in better planning surgeries and improving patient outcomes.

背景和目的:解剖因素在预测根治性前列腺切除术(RP)术后预后中的作用仍不明确。本综述旨在评估各种解剖因素对局部前列腺癌(PCa)根治术患者围手术期预后的影响:方法:使用 PubMed/Medline、Embase 和 Web of Science 数据库对截至 2024 年 1 月的文献进行了全面检索。在确定符合条件的研究时,遵循了《系统综述和荟萃分析首选报告项目》指南。提取并汇总数据进行荟萃分析,结果包括手术时间、失血量、输血率、总体并发症和手术切缘阳性(PSMs)。使用 Cochrane Q 检验评估异质性,并进行亚组分析以探讨手术方法的影响:共有 91 项研究符合我们的纳入标准。在解剖学因素中,前列腺体积(PV)、前列腺重量和中叶(ML)适合进行荟萃分析。前列腺体积越大,手术时间、失血量和并发症发生率越高,但前列腺增生症(PSM)发生率越低(均为 p 结论和临床影响):解剖因素,尤其是前列腺体积,在前列腺电切术的结果中起着重要作用。较大的前列腺与较高的并发症发生率有关,但 PSM 的发生率较低。有必要使用标准化的结果测量方法进行进一步研究,以明确这些关系并指导临床决策。患者总结:在这项研究中,我们探讨了患者的个体解剖结构如何影响前列腺癌手术的结果。我们发现,较大的前列腺往往会导致手术时间延长和失血量增加,但这些前列腺留下癌细胞的风险也较低。这些发现可以帮助医生更好地规划手术,改善患者的治疗效果。
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引用次数: 0
Repeat Prostate Cancer Screening using Blood-based Risk Prediction or Prostate-specific Antigen in the Era of Magnetic Resonance Imaging-guided Biopsies : A Secondary Analysis of the STHLM3-MRI Randomized Clinical Trial. 在磁共振成像引导活检时代使用基于血液的风险预测或前列腺特异性抗原进行前列腺癌重复筛查 :STHLM3-MRI随机临床试验的二次分析。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-18 DOI: 10.1016/j.euo.2024.10.016
Andrea Discacciati, Ahmad Abbadi, Mark S Clements, Magnus Annerstedt, Stefan Carlsson, Henrik Grönberg, Fredrik Jäderling, Martin Eklund, Tobias Nordström

Background and objective: The use of blood-based risk prediction tools has been proposed to improve prostate cancer screening, but data on repeated screening are lacking. Our aim was to compare outcomes using the blood tests prostate-specific antigen (PSA) and Stockholm3 for repeat prostate cancer screening.

Methods: In the population-based screening-by-invitation STHLM3-MRI trial, men aged 50-74 yr were invited to participate in screening. At 2-3 yr after the initial round, men with PSA ≥1.5 ng/ml at trial inclusion who were randomized to magnetic resonance imaging (MRI)-enhanced screening and were not diagnosed with prostate cancer after the initial round were invited for repeat screening involving analysis of PSA and Stockholm3. Biparametric 1.5-T MRI was performed in cases with PSA ≥3 ng/ml or Stockholm3 ≥0.11. Men with Prostate Imaging0Reporting and Data System ≥3 lesions were referred for targeted plus systematic biopsies. The primary outcome was Gleason ≥7 cancer. Secondary outcomes included the number of MRI scans and biopsy procedures, and detection of Gleason 6 and Gleason ≥4 + 3 cancer. Outcomes were compared using the relative positive fractions (RPF).

Key findings and limitations: Of 7609 men from the initial screening round, 2078 were eligible for repeat screening and 1500 (72%) participated. For detection of Gleason ≥7 prostate cancer, the area under the receiver operating characteristic curve was 0.765 (95% confidence interval [CI] 0.725-0.805) for Stockholm3 and 0.651 (95% CI 0.601-0.701) for PSA. Stockholm3 ≥0.15 was associated with 41% fewer MRI scans in comparison to PSA ≥3 ng/ml (RPF 0.59, 95%CI 0.54-0.64), while the detection of GS ≥4 + 3 cancers was similar (RPF 1.00, 95% CI 0.78-1.29). Stockholm3 ≥0.15 detected fewer Gleason ≥7 (RPF 0.75, 95% CI 0.59-0.95) and Gleason 6 (RPF 0.73, 95% CI 0.46-1.16) cancers. Stockholm3 ≥0.11 was associated with no decrease in the number of MRI scans, but an increase of the number of cancer cases detected. Limitations include the lack of long-term outcomes.

Conclusions and clinical implications: Use of the Stockholm3 test for repeated prostate cancer screening could reduce the need for MRI while maintaining detection rates for high-risk cancer.

Patient summary: In this study, we invited men to a second round of prostate cancer screening. We found that use of a new blood test called Stockholm3 can make screening programs more efficient by using fewer resources while still detecting aggressive cancers.

背景和目的:有人提出使用基于血液的风险预测工具来改善前列腺癌筛查,但缺乏重复筛查的数据。我们的目的是比较使用血液检测前列腺特异性抗原(PSA)和斯德哥尔摩3指数进行前列腺癌重复筛查的结果:在基于人群的邀请筛查 STHLM3-MRI 试验中,50-74 岁的男性被邀请参加筛查。在首轮筛查结束后 2-3 年,随机接受磁共振成像(MRI)增强筛查且在首轮筛查后未被确诊为前列腺癌的男性被邀请进行重复筛查,其中包括 PSA 和 Stockholm3 分析。对PSA≥3纳克/毫升或Stockholm3≥0.11的病例进行双参数1.5T磁共振成像检查。前列腺成像0报告和数据系统≥3病变的男性将被转诊进行靶向加系统活检。主要结果是Gleason≥7癌症。次要结果包括 MRI 扫描和活检次数,以及 Gleason 6 和 Gleason ≥4 + 3 癌症的检出率。结果采用相对阳性率(RPF)进行比较:在首轮筛查的 7609 名男性中,有 2078 人符合重复筛查的条件,其中 1500 人(72%)参加了重复筛查。在检测格里森≥7的前列腺癌时,斯德哥尔摩3型的接收者操作特征曲线下面积为0.765(95%置信区间[CI] 0.725-0.805),PSA的接收者操作特征曲线下面积为0.651(95%置信区间[CI] 0.601-0.701)。与 PSA ≥3 ng/ml 相比,Stockholm3 ≥0.15 与 MRI 扫描次数减少 41% 相关(RPF 0.59,95%CI 0.54-0.64),而 GS ≥4 + 3 癌症的检出率相似(RPF 1.00,95% CI 0.78-1.29)。Stockholm3≥0.15检出的Gleason≥7(RPF 0.75,95% CI 0.59-0.95)和Gleason 6(RPF 0.73,95% CI 0.46-1.16)癌症较少。Stockholm3≥0.11与核磁共振成像扫描次数的减少无关,但与癌症病例检测次数的增加有关。不足之处包括缺乏长期结果:在前列腺癌重复筛查中使用斯德哥尔摩 3 检验可减少对核磁共振成像的需求,同时保持高风险癌症的检出率。患者摘要:在这项研究中,我们邀请男性参加第二轮前列腺癌筛查。我们发现,使用一种名为 "Stockholm3 "的新型血液检验可以减少筛查资源的使用,从而提高筛查项目的效率,同时还能检测出侵袭性癌症。
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引用次数: 0
Colibactin Exerts Androgen-dependent and -independent Effects on Prostate Cancer. 高立克次碱对前列腺癌具有依赖性和非依赖性作用
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-14 DOI: 10.1016/j.euo.2024.10.015
Raag Agrawal, Sarah Al-Hiyari, Rupert Hugh-White, Robert Hromas, Yash Patel, Elizabeth A Williamson, Mohammed F E Mootor, Alfredo Gonzalez, Jianmin Fu, Roni Haas, Madison Jordan, Brian L Wickes, Ghouse Mohammed, Mao Tian, Molly J Doris, Christian Jobin, Kevin M Wernke, Yu Pan, Takafumi N Yamaguchi, Seth B Herzon, Paul C Boutros, Michael A Liss

Background and objective: The etiology of prostate cancer (PC) is multifactorial and poorly understood. It has been suggested that colibactin-producing Escherichia coli positive for the pathogenicity island pks (pks+) initiate cancers via induction of genomic instability. In PC, androgens promote oncogenic translocations. Our aim was to investigate the association of pks+E. coli with PC diagnosis and molecular architecture, and its relationship with androgens.

Methods: We quantified the association of pks+E. coli with PC diagnosis in a volunteer-sampled 235-person cohort from two institutional practices (UT San Antonio). We then used colibactin 742 and DNA/RNA sequencing to evaluate the effects of colibactin 742, dihydrotestosterone (DHT), and their combination in vitro.

Key findings and limitations: Colibactin exposure was positively associated with PC diagnosis (p = 0.04) in our clinical cohort, and significantly increased replication fork stalling and fusions in vitro (p < 0.01). Combined in vitro exposure to colibactin 742 and DHT induced more somatic mutations of all types than exposure to either alone. The combination also elicited kataegis, with a higher density of somatic point mutations. Laboratory analyses were conducted using a single cell line, which limited our ability to fully recapitulate the complexity of PC etiology.

Conclusions and clinical implications: Our findings are consistent with synergistic induction of genome instability and kataegis by colibactin 742 and DHT in cell culture. Colibactin-producing pks+ E. coli may plausibly contribute to PC etiology.

Patient summary: We investigated whether a bacterial toxin that is linked to colon cancer can also cause prostate cancer. Our results support this idea by showing a link between the toxin and prostate cancer diagnosis in a large patient population. We also found that this toxin causes genetic dysfunction in prostate cancer cells when combined with testosterone.

背景和目的:前列腺癌(PC)的病因是多因素的,目前尚不清楚。有人认为,致病性岛 pks(pks+)阳性的产大肠杆菌通过诱导基因组不稳定性引发癌症。在 PC 中,雄激素会促进致癌易位。我们的目的是研究 pks+ 大肠杆菌与 PC 诊断和分子结构的关联及其与雄激素的关系:方法:我们从两家机构(UT 圣安东尼奥)的 235 人队列中对 pks+E. coli 与 PC 诊断的相关性进行了量化。然后,我们使用 colibactin 742 和 DNA/RNA 测序来评估 colibactin 742、双氢睾酮 (DHT) 及其组合在体外的影响:在我们的临床队列中,高立克次素暴露与 PC 诊断呈正相关(p = 0.04),并显著增加了体外复制叉停滞和融合(p 结论和临床意义:我们的研究结果表明,在细胞培养过程中,可乐菌素 742 和 DHT 可协同诱导基因组不稳定性和卡他性。患者总结:我们研究了一种与结肠癌有关的细菌毒素是否也会导致前列腺癌。我们的研究结果表明,在大量患者中,该毒素与前列腺癌诊断之间存在联系,从而支持了这一观点。我们还发现,当这种毒素与睾酮结合时,会导致前列腺癌细胞的基因功能紊乱。
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引用次数: 0
Combined Fixed-duration Systemic Treatment and Metastasis-directed Radiotherapy for Oligometastatic Hormone-sensitive Prostate Cancer. 针对寡转移性激素敏感性前列腺癌的固定疗程全身治疗和转移灶定向放疗联合疗法。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-14 DOI: 10.1016/j.euo.2024.10.014
Praful Ravi, Caiwei Zhong, Wanling Xie, Emma Kelly, Bridget Whelpley, Katelyn Kuczmarski, Himisha Beltran, Kerry L Kilbridge, Martin T King, Bradley A McGregor, Alicia K Morgans, Mark Pomerantz, Mary-Ellen Taplin, Alok K Tewari, Srinivas R Viswanathan, Xiao X Wei, Mai Anh Huynh, Atish D Choudhury

Background and objective: It is unclear whether "total therapy" (androgen deprivation therapy [ADT] with or without an androgen receptor pathway inhibitor [ARPI], metastasis-directed therapy, and local therapy to the prostate if de novo) may lead to long-term durable remission in oligometastatic hormone-sensitive prostate cancer (omHSPC). This study aims to evaluate the outcomes after the completion of total therapy in patients with omHSPC.

Methods: A retrospective single-institution cohort of consecutive patients with omHSPC identified on conventional or molecular imaging treated with total therapy was assembled. All patients had prostate-specific antigen ≤0.1 ng/ml at the completion of systemic therapy. Kaplan-Meier and Cox regression models were used to evaluate the key outcomes of interest: clinical progression-free survival (cPFS), eugonadal progression-free survival (PFS), and time to restart of ADT (TTrADT).

Key findings and limitations: Eighty-nine patients were included, of whom 23 were with de novo omHSPC; the median number of metastases was 1, and detection of disease by molecular imaging was performed in 43 patients (48%). Forty-nine patients (55%) received ADT + ARPI doublet and 40 (45%) received ADT alone. At a median follow-up of 37 mo, there were 46 cPFS events; 3-yr cPFS rate was 45% (95% confidence interval 33-56) and the median eugonadal PFS was 12 mo. The median TTrADT was 47 mo, and 60% had not restarted ADT at 3 yr. Duration of systemic therapy ≥12 mo was the only significant predictor of better outcomes.

Conclusions and clinical implications: Of the patients receiving total therapy for omHSPC, 45% remained progression free at 3 yr after completing therapy, hinting at the potential for long-term remission and possible cure with this strategy in a subset of patients with omHSPC. Prospective trials evaluating this approach are needed.

Patient summary: In this report, we looked at outcomes in men who had received a fixed duration of hormonal therapy along with radiotherapy to metastatic sites (and prostate radiotherapy or surgery in those with newly diagnosed disease) for oligometastatic prostate cancer. We found that nearly half of the patients had no evidence of cancer recurrence at 3 yr after completing therapy, and 60% had not resumed any therapy at this time point.

背景和目的:目前尚不清楚 "综合治疗"(使用或不使用雄激素受体通路抑制剂[ARPI]的雄激素剥夺疗法[ADT]、转移灶导向疗法和新发前列腺局部疗法)是否能使寡转移性激素敏感性前列腺癌(omHSPC)获得长期持久的缓解。本研究旨在评估omHSPC患者完成整体治疗后的疗效:方法:研究人员对在常规或分子影像学检查中发现的接受整体治疗的连续omHSPC患者进行了回顾性单机构队列分析。所有患者在完成系统治疗时前列腺特异性抗原均≤0.1 ng/ml。采用卡普兰-梅耶(Kaplan-Meier)和考克斯回归模型评估主要的相关结果:临床无进展生存期(cPFS)、优生无进展生存期(PFS)和重新开始 ADT 的时间(TTrADT):共纳入89例患者,其中23例为新发omHSPC;转移灶的中位数为1个,43例患者(48%)通过分子影像学检查发现了疾病。49名患者(55%)接受了ADT+ARPI双联疗法,40名患者(45%)仅接受了ADT疗法。中位随访时间为 37 个月,有 46 例 cPFS 事件;3 年 cPFS 率为 45%(95% 置信区间为 33-56),中位优生 PFS 为 12 个月。中位TTrADT为47个月,60%的患者在3年后未重新开始ADT,系统治疗持续时间≥12个月是唯一显著预测较好结果的因素:在接受omHSPC整体治疗的患者中,45%的患者在完成治疗3年后仍未出现病情进展,这表明在一部分omHSPC患者中,采用这种策略有可能获得长期缓解和治愈。患者摘要:在这份报告中,我们研究了接受固定时间的激素治疗并对转移部位进行放疗(对新确诊的患者进行前列腺放疗或手术)的男性少转移性前列腺癌患者的治疗效果。我们发现,近一半的患者在完成治疗 3 年后没有癌症复发的迹象,60% 的患者在这个时间点没有恢复任何治疗。
{"title":"Combined Fixed-duration Systemic Treatment and Metastasis-directed Radiotherapy for Oligometastatic Hormone-sensitive Prostate Cancer.","authors":"Praful Ravi, Caiwei Zhong, Wanling Xie, Emma Kelly, Bridget Whelpley, Katelyn Kuczmarski, Himisha Beltran, Kerry L Kilbridge, Martin T King, Bradley A McGregor, Alicia K Morgans, Mark Pomerantz, Mary-Ellen Taplin, Alok K Tewari, Srinivas R Viswanathan, Xiao X Wei, Mai Anh Huynh, Atish D Choudhury","doi":"10.1016/j.euo.2024.10.014","DOIUrl":"https://doi.org/10.1016/j.euo.2024.10.014","url":null,"abstract":"<p><strong>Background and objective: </strong>It is unclear whether \"total therapy\" (androgen deprivation therapy [ADT] with or without an androgen receptor pathway inhibitor [ARPI], metastasis-directed therapy, and local therapy to the prostate if de novo) may lead to long-term durable remission in oligometastatic hormone-sensitive prostate cancer (omHSPC). This study aims to evaluate the outcomes after the completion of total therapy in patients with omHSPC.</p><p><strong>Methods: </strong>A retrospective single-institution cohort of consecutive patients with omHSPC identified on conventional or molecular imaging treated with total therapy was assembled. All patients had prostate-specific antigen ≤0.1 ng/ml at the completion of systemic therapy. Kaplan-Meier and Cox regression models were used to evaluate the key outcomes of interest: clinical progression-free survival (cPFS), eugonadal progression-free survival (PFS), and time to restart of ADT (TTrADT).</p><p><strong>Key findings and limitations: </strong>Eighty-nine patients were included, of whom 23 were with de novo omHSPC; the median number of metastases was 1, and detection of disease by molecular imaging was performed in 43 patients (48%). Forty-nine patients (55%) received ADT + ARPI doublet and 40 (45%) received ADT alone. At a median follow-up of 37 mo, there were 46 cPFS events; 3-yr cPFS rate was 45% (95% confidence interval 33-56) and the median eugonadal PFS was 12 mo. The median TTrADT was 47 mo, and 60% had not restarted ADT at 3 yr. Duration of systemic therapy ≥12 mo was the only significant predictor of better outcomes.</p><p><strong>Conclusions and clinical implications: </strong>Of the patients receiving total therapy for omHSPC, 45% remained progression free at 3 yr after completing therapy, hinting at the potential for long-term remission and possible cure with this strategy in a subset of patients with omHSPC. Prospective trials evaluating this approach are needed.</p><p><strong>Patient summary: </strong>In this report, we looked at outcomes in men who had received a fixed duration of hormonal therapy along with radiotherapy to metastatic sites (and prostate radiotherapy or surgery in those with newly diagnosed disease) for oligometastatic prostate cancer. We found that nearly half of the patients had no evidence of cancer recurrence at 3 yr after completing therapy, and 60% had not resumed any therapy at this time point.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Systematic Review of the Diagnostic Accuracy of Deep Learning Models for the Automatic Detection, Localization, and Characterization of Clinically Significant Prostate Cancer on Magnetic Resonance Imaging. 深度学习模型在磁共振成像中对有临床意义的前列腺癌进行自动检测、定位和定性的诊断准确性系统性综述》。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-14 DOI: 10.1016/j.euo.2024.11.001
Sébastien Molière, Dimitri Hamzaoui, Guillaume Ploussard, Romain Mathieu, Gaelle Fiard, Michael Baboudjian, Benjamin Granger, Morgan Roupret, Hervé Delingette, Raphaele Renard-Penna

Background and objective: Magnetic resonance imaging (MRI) plays a critical role in prostate cancer diagnosis, but is limited by variability in interpretation and diagnostic accuracy. This systematic review evaluates the current state of deep learning (DL) models in enhancing the automatic detection, localization, and characterization of clinically significant prostate cancer (csPCa) on MRI.

Methods: A systematic search was conducted across Medline/PubMed, Embase, Web of Science, and ScienceDirect for studies published between January 2020 and September 2023. Studies were included if these presented and validated fully automated DL models for csPCa detection on MRI, with pathology confirmation. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool and the Checklist for Artificial Intelligence in Medical Imaging.

Key findings and limitations: Twenty-five studies met the inclusion criteria, showing promising results in detecting and characterizing csPCa. However, significant heterogeneity in study designs, validation strategies, and datasets complicates direct comparisons. Only one-third of studies performed external validation, highlighting a critical gap in generalizability. The reliance on internal validation limits a broader application of these findings, and the lack of standardized methodologies hinders the integration of DL models into clinical practice.

Conclusions and clinical implications: DL models demonstrate significant potential in improving prostate cancer diagnostics on MRI. However, challenges in validation, generalizability, and clinical implementation must be addressed. Future research should focus on standardizing methodologies, ensuring external validation and conducting prospective clinical trials to facilitate the adoption of artificial intelligence (AI) in routine clinical settings. These findings support the cautious integration of AI into clinical practice, with further studies needed to confirm their efficacy in diverse clinical environments.

Patient summary: In this study, we reviewed how artificial intelligence (AI) models can help doctors better detect and understand aggressive prostate cancer using magnetic resonance imaging scans. We found that while these AI tools show promise, these tools need more testing and validation in different hospitals before these can be used widely in patient care.

背景和目的:磁共振成像(MRI)在前列腺癌诊断中起着至关重要的作用,但受限于解释和诊断准确性的可变性。这篇系统性综述评估了深度学习(DL)模型在增强磁共振成像上具有临床意义的前列腺癌(csPCa)的自动检测、定位和定性方面的现状:在 Medline/PubMed、Embase、Web of Science 和 ScienceDirect 上对 2020 年 1 月至 2023 年 9 月间发表的研究进行了系统检索。如果这些研究提出并验证了在 MRI 上检测 csPCa 的全自动 DL 模型,并经病理学确认,则纳入这些研究。研究质量采用诊断准确性研究质量评估-2(QUADAS-2)工具和医学影像人工智能检查表进行评估:25项研究符合纳入标准,在检测和描述csPCa方面显示出良好的结果。但是,由于研究设计、验证策略和数据集存在明显的异质性,使得直接比较变得复杂。只有三分之一的研究进行了外部验证,这凸显了可推广性方面的关键差距。对内部验证的依赖限制了这些发现的更广泛应用,而标准化方法的缺乏则阻碍了DL模型与临床实践的结合:DL模型在改善磁共振成像前列腺癌诊断方面具有巨大潜力。然而,必须解决验证、通用性和临床实施方面的挑战。未来的研究应侧重于方法标准化、确保外部验证和开展前瞻性临床试验,以促进人工智能(AI)在常规临床环境中的应用。患者总结:在这项研究中,我们回顾了人工智能(AI)模型如何帮助医生利用磁共振成像扫描更好地检测和了解侵袭性前列腺癌。我们发现,虽然这些人工智能工具显示出了前景,但这些工具还需要在不同的医院进行更多的测试和验证,然后才能在患者护理中广泛使用。
{"title":"A Systematic Review of the Diagnostic Accuracy of Deep Learning Models for the Automatic Detection, Localization, and Characterization of Clinically Significant Prostate Cancer on Magnetic Resonance Imaging.","authors":"Sébastien Molière, Dimitri Hamzaoui, Guillaume Ploussard, Romain Mathieu, Gaelle Fiard, Michael Baboudjian, Benjamin Granger, Morgan Roupret, Hervé Delingette, Raphaele Renard-Penna","doi":"10.1016/j.euo.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.euo.2024.11.001","url":null,"abstract":"<p><strong>Background and objective: </strong>Magnetic resonance imaging (MRI) plays a critical role in prostate cancer diagnosis, but is limited by variability in interpretation and diagnostic accuracy. This systematic review evaluates the current state of deep learning (DL) models in enhancing the automatic detection, localization, and characterization of clinically significant prostate cancer (csPCa) on MRI.</p><p><strong>Methods: </strong>A systematic search was conducted across Medline/PubMed, Embase, Web of Science, and ScienceDirect for studies published between January 2020 and September 2023. Studies were included if these presented and validated fully automated DL models for csPCa detection on MRI, with pathology confirmation. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool and the Checklist for Artificial Intelligence in Medical Imaging.</p><p><strong>Key findings and limitations: </strong>Twenty-five studies met the inclusion criteria, showing promising results in detecting and characterizing csPCa. However, significant heterogeneity in study designs, validation strategies, and datasets complicates direct comparisons. Only one-third of studies performed external validation, highlighting a critical gap in generalizability. The reliance on internal validation limits a broader application of these findings, and the lack of standardized methodologies hinders the integration of DL models into clinical practice.</p><p><strong>Conclusions and clinical implications: </strong>DL models demonstrate significant potential in improving prostate cancer diagnostics on MRI. However, challenges in validation, generalizability, and clinical implementation must be addressed. Future research should focus on standardizing methodologies, ensuring external validation and conducting prospective clinical trials to facilitate the adoption of artificial intelligence (AI) in routine clinical settings. These findings support the cautious integration of AI into clinical practice, with further studies needed to confirm their efficacy in diverse clinical environments.</p><p><strong>Patient summary: </strong>In this study, we reviewed how artificial intelligence (AI) models can help doctors better detect and understand aggressive prostate cancer using magnetic resonance imaging scans. We found that while these AI tools show promise, these tools need more testing and validation in different hospitals before these can be used widely in patient care.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biopsy-based Basal-luminal Subtyping Classifier in High-risk Prostate Cancer: A Combined Analysis of the NRG Oncology/RTOG 9202, 9413, and 9902 Phase 3 Trials. 基于活检的高危前列腺癌基底腔亚型分类器:NRG Oncology/RTOG 9202、9413 和 9902 3 期试验的综合分析。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-13 DOI: 10.1016/j.euo.2024.10.017
Krishnan R Patel, Paul L Nguyen, James A Proudfoot, Yang Liu, Alan Dal Pra, Daniel E Spratt, Alan Pollack, Howard M Sandler, Jason A Efstathiou, Colleen Lawton, Jeffry P Simko, Seth A Rosenthal, Kenneth L Zeitzer, Lucas C Mendez, Alan C Hartford, William A Hall, Anand B Desai, Stephanie L Pugh, Elai Davicioni, Phuoc T Tran, Felix Y Feng

Background and objective: Long-term (LT) androgen deprivation therapy (ADT) has been found to be beneficial to patients with high-risk prostate cancer (PCa). However, administration of LT-ADT to all patients with high-risk PCa may lead to overtreatment. Enhanced risk stratification using genomic classifiers (such as the recently developed prostate subtyping classifier [PSC]) might be useful. This study aims to characterize the prognostic and predictive ability of the PSC in patients with high-risk PCa undergoing radiotherapy long-term (LT; 24-28 mo) versus short-term (ST; 4 mo) ADT.

Methods: Biopsy samples from three randomized, phase 3 trials-NRG/RTOG 9202, 9413, and 9902-were classified as either PSC basal or luminal. The prognostic and predictive values of PSC for each oncologic endpoint (biochemical failure [BF], distant metastasis [DM], metastasis-free survival [MFS], PCa-specific mortality [PCSM], overall survival [OS]) and other cause-mortality (OCM) were assessed with Cox proportional hazards (MFS, OCM, and OS), Fine-Gray (BF, DM, and PCSM), and restricted mean survival time (RMST) models.

Key findings and limitations: On a multivariable analysis, the basal subtype was found to have a worse prognosis for MFS (hazard ratio [HR] 1.8 [1.3-2.5], p < 0.001), PCSM (subdistribution HR 2.4 [95% confidence interval {CI} 1.4-4.1], p = 0.001), and OS (HR 1.8 [1.3-2.6], p < 0.001). Ten-year PCSM was 15% better for the luminal subtype than for the basal subtype (11% [95% CI 6-15%] vs 26% [95% CI 17-35%]). A significant interaction between ADT duration (LT vs ST) and PSC subtype (basal vs luminal) was observed for PCSM (pinteraction = 0.008), leading to the observation that 10-yr PCSM was improved with LT-ADT only in patients with basal-type tumors (5% [95% CI 0-11%] vs 42% [29-56%], p < 0.001). Improvements in 10-yr RMST with LT-ADT were greater for basal tumors for oncologic endpoints with the exception of OCM.

Conclusions and clinical implications: PSC is both a prognostic and a predictive biomarker for patients who benefit from LT-ADT. PSC subtypes may be used to personalize ADT recommendations for patients with high-risk PCa, pending further validation in a prospective study.

Patient summary: In this study, we tried to understand the usefulness of a new genomic test in patients with high-risk, nonmetastatic prostate cancer who underwent radiation therapy and hormonal therapy (HT). We found that this test can help determine a patient's prognosis (eg, a patient's chance of having the cancer return) and, more importantly, personalize treatment decisions by understanding which patients may benefit from long-term HT. This has the potential to save many patients who may not benefit from prolonged HT from "overtreatment" or the unnecessary side effects of such treatment.

背景和目的:研究发现,长期(LT)雄激素剥夺疗法(ADT)对高危前列腺癌(PCa)患者有益。然而,对所有高危 PCa 患者实施 LT-ADT 可能会导致过度治疗。利用基因组分类器(如最近开发的前列腺亚型分类器 [PSC])加强风险分层可能会有所帮助。本研究旨在描述PSC在长期(LT;24-28个月)与短期(ST;4个月)ADT放疗的高危PCa患者中的预后和预测能力:来自三项随机三期试验--NRG/RTOG 9202、9413 和 9902 的活检样本被分为基底型 PSC 和管腔型 PSC。采用 Cox 比例危险度模型(MFS、OCM 和 OS)、Fine-Gray 模型(BF、DM 和 PCSM)和受限平均生存时间模型(RMST)评估了 PSC 对各肿瘤终点(生化失败 [BF]、远处转移 [DM]、无转移生存期 [MFS]、PCa 特异性死亡率 [PCSM]、总生存期 [OS])和其他原因死亡率 (OCM) 的预后和预测价值:在一项多变量分析中发现,基底亚型患者的 MFS 预后较差(危险比 [HR] 1.8 [1.3-2.5],P 交互作用 = 0.008),从而观察到只有基底型肿瘤患者的 10 年 PCSM 可通过 LT-ADT 得到改善(5% [95% CI 0-11%] vs 42% [29-56%],P 结论和临床意义:PSC既是LT-ADT获益患者的预后生物标志物,也是预测性生物标志物。PSC亚型可用于为高危PCa患者提供个性化的ADT建议,但还有待于前瞻性研究的进一步验证。患者总结:在这项研究中,我们试图了解一种新的基因组检验对接受放疗和激素治疗(HT)的高危、非转移性前列腺癌患者的作用。我们发现,这种检测有助于确定患者的预后(例如,患者癌症复发的几率),更重要的是,通过了解哪些患者可能从长期激素治疗中获益,从而做出个性化的治疗决定。这有可能使许多可能无法从长期高温治疗中获益的患者免于 "过度治疗 "或这种治疗不必要的副作用。
{"title":"Biopsy-based Basal-luminal Subtyping Classifier in High-risk Prostate Cancer: A Combined Analysis of the NRG Oncology/RTOG 9202, 9413, and 9902 Phase 3 Trials.","authors":"Krishnan R Patel, Paul L Nguyen, James A Proudfoot, Yang Liu, Alan Dal Pra, Daniel E Spratt, Alan Pollack, Howard M Sandler, Jason A Efstathiou, Colleen Lawton, Jeffry P Simko, Seth A Rosenthal, Kenneth L Zeitzer, Lucas C Mendez, Alan C Hartford, William A Hall, Anand B Desai, Stephanie L Pugh, Elai Davicioni, Phuoc T Tran, Felix Y Feng","doi":"10.1016/j.euo.2024.10.017","DOIUrl":"10.1016/j.euo.2024.10.017","url":null,"abstract":"<p><strong>Background and objective: </strong>Long-term (LT) androgen deprivation therapy (ADT) has been found to be beneficial to patients with high-risk prostate cancer (PCa). However, administration of LT-ADT to all patients with high-risk PCa may lead to overtreatment. Enhanced risk stratification using genomic classifiers (such as the recently developed prostate subtyping classifier [PSC]) might be useful. This study aims to characterize the prognostic and predictive ability of the PSC in patients with high-risk PCa undergoing radiotherapy long-term (LT; 24-28 mo) versus short-term (ST; 4 mo) ADT.</p><p><strong>Methods: </strong>Biopsy samples from three randomized, phase 3 trials-NRG/RTOG 9202, 9413, and 9902-were classified as either PSC basal or luminal. The prognostic and predictive values of PSC for each oncologic endpoint (biochemical failure [BF], distant metastasis [DM], metastasis-free survival [MFS], PCa-specific mortality [PCSM], overall survival [OS]) and other cause-mortality (OCM) were assessed with Cox proportional hazards (MFS, OCM, and OS), Fine-Gray (BF, DM, and PCSM), and restricted mean survival time (RMST) models.</p><p><strong>Key findings and limitations: </strong>On a multivariable analysis, the basal subtype was found to have a worse prognosis for MFS (hazard ratio [HR] 1.8 [1.3-2.5], p < 0.001), PCSM (subdistribution HR 2.4 [95% confidence interval {CI} 1.4-4.1], p = 0.001), and OS (HR 1.8 [1.3-2.6], p < 0.001). Ten-year PCSM was 15% better for the luminal subtype than for the basal subtype (11% [95% CI 6-15%] vs 26% [95% CI 17-35%]). A significant interaction between ADT duration (LT vs ST) and PSC subtype (basal vs luminal) was observed for PCSM (p<sub>interaction</sub> = 0.008), leading to the observation that 10-yr PCSM was improved with LT-ADT only in patients with basal-type tumors (5% [95% CI 0-11%] vs 42% [29-56%], p < 0.001). Improvements in 10-yr RMST with LT-ADT were greater for basal tumors for oncologic endpoints with the exception of OCM.</p><p><strong>Conclusions and clinical implications: </strong>PSC is both a prognostic and a predictive biomarker for patients who benefit from LT-ADT. PSC subtypes may be used to personalize ADT recommendations for patients with high-risk PCa, pending further validation in a prospective study.</p><p><strong>Patient summary: </strong>In this study, we tried to understand the usefulness of a new genomic test in patients with high-risk, nonmetastatic prostate cancer who underwent radiation therapy and hormonal therapy (HT). We found that this test can help determine a patient's prognosis (eg, a patient's chance of having the cancer return) and, more importantly, personalize treatment decisions by understanding which patients may benefit from long-term HT. This has the potential to save many patients who may not benefit from prolonged HT from \"overtreatment\" or the unnecessary side effects of such treatment.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unmet Need in Non-muscle-invasive Bladder Cancer Failing Bacillus Calmette-Guérin Therapy: A Systematic Review and Cost-effectiveness Analyses from the International Bladder Cancer Group. 卡介苗疗法失败的非肌层浸润性膀胱癌患者未满足的需求:国际膀胱癌小组的系统回顾和成本效益分析》。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-12 DOI: 10.1016/j.euo.2024.10.012
David D'Andrea, Hugh Mostafid, Paolo Gontero, Shahrokh Shariat, Ashish Kamat, Alexandra Masson-Lecomte, Maximilian Burger, Morgan Rouprêt
<p><strong>Background and objective: </strong>Non-muscle-invasive bladder cancer (NMIBC) poses a significant clinical challenge, particularly when failing bacillus Calmette-Guérin (BCG) therapy, necessitating alternative treatments. Despite radical cystectomy being the recommended treatment, many patients are unfit or unwilling to undergo this invasive procedure, highlighting the need for effective bladder-sparing therapies. This review aims to summarize and report the evidence on the efficacy and to estimate the costs of bladder-preserving strategies used in NMIBC recurrence after failure of intravesical BCG therapy.</p><p><strong>Methods: </strong>We systematically searched online databases for prospective studies investigating intravesical therapy, systemic therapy, or combination of both in patients treated previously with BCG. Owing to significant heterogeneity across the studies, a meta-analysis was inappropriate. A sensitivity analysis was performed in an exploratory manner. We used a decision-analytic Markov model to compare novel U.S. Food and Drug Administration-approved treatments with a 2-yr time horizon.</p><p><strong>Key findings and limitations: </strong>A total of 57 studies published between 1998 and 2024, with 68 unique study arms and consisting of 2589 patients, were identified. The 3-mo overall response rate (ORR) across all studies, complete response rate (CRR) in concomitant carcinoma in situ (CIS) or CIS only disease, and recurrence-free rate (RFR) in papillary disease were estimated to be 52.4% (95% confidence interval [CI]: 45.4-59.2), 52.8% (95% CI: 42.9-62.6), and 26.4% (95% CI: 13.3-45.6), respectively. The 12-mo ORR, CRR, and RFR were estimated to be 78% (95% CI: 52.9-91.8), 27.8% (95% CI: 21.3-35.4), and 25.4% (95% CI: 18.2-34.2), respectively. The progression rate was estimated to be 13% (95% CI: 9-18.2). The mean proportion of patients treated with radical cystectomy was estimated to be 24.7 (range 0-85.7). The reported toxicity grades were overall mild, with a median of 3.4% (range 0-33.3%) participants experiencing a dose limiting toxicity. Compared with using radical cystectomy to treat patients failing BCG therapy, at a willingness-to-pay threshold of 100 000 USD, nadofaragene firadenovec was cost effective, with an incremental cost-effectiveness ratio (ICER) of 10 014 USD per quality-adjusted life year (QALY), while nogapendekin alfa inbakicept was less cost effective than nadofaragene firadenovec (ICER of 44 602 USD per QALY). Pembrolizumab, which dominated, was both less costly and more effective than the other strategies.</p><p><strong>Conclusions and clinical implications: </strong>Salvage bladder-sparing therapies show a response rate of around 50% at 3 mo in patients with NMIBC failing BCG. However, long-term data are heterogeneous. Nevertheless, recently developed agents show promising tumor control activity. In the rapidly evolving landscape of urothelial cancer, some of these treatment strategies migh
背景和目的:非肌层浸润性膀胱癌(NMIBC)是一项重大的临床挑战,尤其是在卡介苗(BCG)治疗失败的情况下,需要采用替代疗法。尽管根治性膀胱切除术是推荐的治疗方法,但许多患者不适合或不愿意接受这种侵入性手术,这凸显了对有效保膀胱疗法的需求。本综述旨在总结和报告用于膀胱内卡介苗治疗失败后 NMIBC 复发的膀胱保留策略的疗效证据,并估算其成本:我们系统地检索了在线数据库,以了解对既往接受过卡介苗治疗的患者进行膀胱内治疗、全身治疗或两者结合治疗的前瞻性研究。由于各研究之间存在明显的异质性,因此不适合进行荟萃分析。我们以探索性的方式进行了敏感性分析。我们使用了一个决策分析马尔可夫模型来比较美国食品药品管理局批准的新型治疗方法,时间跨度为2年:我们共确定了 1998 年至 2024 年间发表的 57 项研究,其中有 68 个独特的研究臂,包括 2589 名患者。所有研究的3个月总反应率(ORR)、合并原位癌(CIS)或仅合并CIS疾病的完全反应率(CRR)以及乳头状疾病的无复发率(RFR)估计分别为52.4%(95%置信区间[CI]:45.4-59.2)、52.8%(95% CI:42.9-62.6)和26.4%(95% CI:13.3-45.6)。12个月的ORR、CRR和RFR估计分别为78%(95% CI:52.9-91.8)、27.8%(95% CI:21.3-35.4)和25.4%(95% CI:18.2-34.2)。进展率估计为 13%(95% CI:9-18.2)。接受根治性膀胱切除术的患者平均比例估计为 24.7(范围 0-85.7)。报告的毒性等级总体较轻,出现剂量限制性毒性的参与者中位数为 3.4%(范围 0-33.3%)。与使用根治性膀胱切除术治疗卡介苗治疗失败的患者相比,在100,000美元的支付意愿阈值下,纳多法拉基因firadenovec具有成本效益,每质量调整生命年(QALY)的增量成本效益比(ICER)为10,014美元,而诺加彭定康α-inbakicept的成本效益低于纳多法拉基因firadenovec(每质量调整生命年的ICER为44,602美元)。Pembrolizumab占主导地位,其成本和疗效均低于其他疗法:对于卡介苗治疗失败的 NMIBC 患者,挽救性膀胱保护疗法在 3 个月后的反应率约为 50%。然而,长期数据各不相同。不过,最近开发的药物显示出良好的肿瘤控制活性。在尿路上皮癌迅速发展的形势下,其中一些治疗策略可能具有成本效益,并能改善患者的生活质量。患者总结:在这项研究中,我们回顾了在卡介苗(BCG)治疗失败后膀胱癌复发患者中使用的保留膀胱策略的疗效证据。我们发现,这些策略在 3 个月后的反应率约为 50%。不过,最近开发的药物显示出良好的肿瘤控制活性。在尿路癌迅速发展的形势下,其中一些治疗策略可能具有成本效益,并能改善患者的生活质量。
{"title":"Unmet Need in Non-muscle-invasive Bladder Cancer Failing Bacillus Calmette-Guérin Therapy: A Systematic Review and Cost-effectiveness Analyses from the International Bladder Cancer Group.","authors":"David D'Andrea, Hugh Mostafid, Paolo Gontero, Shahrokh Shariat, Ashish Kamat, Alexandra Masson-Lecomte, Maximilian Burger, Morgan Rouprêt","doi":"10.1016/j.euo.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.euo.2024.10.012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;Non-muscle-invasive bladder cancer (NMIBC) poses a significant clinical challenge, particularly when failing bacillus Calmette-Guérin (BCG) therapy, necessitating alternative treatments. Despite radical cystectomy being the recommended treatment, many patients are unfit or unwilling to undergo this invasive procedure, highlighting the need for effective bladder-sparing therapies. This review aims to summarize and report the evidence on the efficacy and to estimate the costs of bladder-preserving strategies used in NMIBC recurrence after failure of intravesical BCG therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We systematically searched online databases for prospective studies investigating intravesical therapy, systemic therapy, or combination of both in patients treated previously with BCG. Owing to significant heterogeneity across the studies, a meta-analysis was inappropriate. A sensitivity analysis was performed in an exploratory manner. We used a decision-analytic Markov model to compare novel U.S. Food and Drug Administration-approved treatments with a 2-yr time horizon.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings and limitations: &lt;/strong&gt;A total of 57 studies published between 1998 and 2024, with 68 unique study arms and consisting of 2589 patients, were identified. The 3-mo overall response rate (ORR) across all studies, complete response rate (CRR) in concomitant carcinoma in situ (CIS) or CIS only disease, and recurrence-free rate (RFR) in papillary disease were estimated to be 52.4% (95% confidence interval [CI]: 45.4-59.2), 52.8% (95% CI: 42.9-62.6), and 26.4% (95% CI: 13.3-45.6), respectively. The 12-mo ORR, CRR, and RFR were estimated to be 78% (95% CI: 52.9-91.8), 27.8% (95% CI: 21.3-35.4), and 25.4% (95% CI: 18.2-34.2), respectively. The progression rate was estimated to be 13% (95% CI: 9-18.2). The mean proportion of patients treated with radical cystectomy was estimated to be 24.7 (range 0-85.7). The reported toxicity grades were overall mild, with a median of 3.4% (range 0-33.3%) participants experiencing a dose limiting toxicity. Compared with using radical cystectomy to treat patients failing BCG therapy, at a willingness-to-pay threshold of 100 000 USD, nadofaragene firadenovec was cost effective, with an incremental cost-effectiveness ratio (ICER) of 10 014 USD per quality-adjusted life year (QALY), while nogapendekin alfa inbakicept was less cost effective than nadofaragene firadenovec (ICER of 44 602 USD per QALY). Pembrolizumab, which dominated, was both less costly and more effective than the other strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and clinical implications: &lt;/strong&gt;Salvage bladder-sparing therapies show a response rate of around 50% at 3 mo in patients with NMIBC failing BCG. However, long-term data are heterogeneous. Nevertheless, recently developed agents show promising tumor control activity. In the rapidly evolving landscape of urothelial cancer, some of these treatment strategies migh","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correlation of Body Mass Index with Overall Survival Among Patients with Metastatic Hormone-sensitive Prostate Cancer: Analysis of Patient-level Data from SWOG-1216. 身体质量指数与转移性激素敏感性前列腺癌患者总生存期的相关性:来自 SWOG-1216 的患者水平数据分析。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-08 DOI: 10.1016/j.euo.2024.10.013
Umang Swami, Yeonjung Jo, Arshit Narang, Melissa Plets, Chadi Hage Chehade, Georges Gebrael, Shilpa Gupta, Zin Myint, Catherine Tangen, Primo N Lara, Ian M Thompson, Maha H A Hussain, Tanya B Dorff, Seth P Lerner, Neeraj Agarwal

Although obesity has been associated with better overall survival (OS) among patients with metastatic castration-resistant prostate cancer, its association with OS has not been extensively explored in metastatic hormone-sensitive prostate cancer (mHSPC). We conducted a post hoc exploratory analysis of patient-level data from the SWOG-1216 trial to determine whether baseline body mass index (BMI) is associated with better OS among patients with mHSPC. SWOG-1216 was an open-label, phase 3 trial that randomized patients newly diagnosed with mHSPC 1:1 to either androgen deprivation therapy (ADT) with orteronel (experimental arm) or ADT with bicalutamide (control arm). Of 1279 patients included in the analysis, 12 (0.9%) were underweight, 252 (19.7%) had normal BMI, 958 (74.9%) were overweight, and 57 (4.5%) were obese. Age, Gleason score, extent of disease burden, the incidence of visceral metastases, and treatment allocation were similar among the groups (p > 0.05), while differences in baseline prostate-specific antigen and Zubrod performance status were observed (p < 0.05). Median OS was 2.4, 5.5, 6.6, and 6.8 yr in the underweight, normal, overweight, and obese groups, respectively. After adjusting for prognostic variables, high BMI was associated with better OS (HR for each increment in BMI category: 0.829, 5% CI 0.68-0.98; p = 0.029). These findings need to be validated in other phase 3 trials. PATIENT SUMMARY: We analyzed data from a clinical trial to evaluate the association between body mass index (BMI) and overall survival among patients with metastatic hormone-sensitive prostate cancer. We found that in this group of patients, the risk of death was lower for patients with higher BMI.

虽然肥胖与转移性阉割耐药前列腺癌患者较好的总生存期(OS)有关,但在转移性激素敏感性前列腺癌(mHSPC)中,肥胖与OS的关系尚未得到广泛探讨。我们对 SWOG-1216 试验的患者水平数据进行了一项事后探索性分析,以确定基线体重指数(BMI)是否与 mHSPC 患者更佳的 OS 有关。SWOG-1216是一项开放标签的3期试验,该试验将新诊断为mHSPC的患者按1:1随机分配到使用奥曲肽的雄激素剥夺疗法(ADT)(试验组)或使用比卡鲁胺的ADT(对照组)。在纳入分析的 1279 名患者中,12 人(0.9%)体重不足,252 人(19.7%)体重指数正常,958 人(74.9%)超重,57 人(4.5%)肥胖。各组的年龄、格里森评分、疾病负担程度、内脏转移发生率和治疗分配相似(P > 0.05),而基线前列腺特异性抗原和祖布罗德表现状态存在差异(P > 0.05)。
{"title":"Correlation of Body Mass Index with Overall Survival Among Patients with Metastatic Hormone-sensitive Prostate Cancer: Analysis of Patient-level Data from SWOG-1216.","authors":"Umang Swami, Yeonjung Jo, Arshit Narang, Melissa Plets, Chadi Hage Chehade, Georges Gebrael, Shilpa Gupta, Zin Myint, Catherine Tangen, Primo N Lara, Ian M Thompson, Maha H A Hussain, Tanya B Dorff, Seth P Lerner, Neeraj Agarwal","doi":"10.1016/j.euo.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.euo.2024.10.013","url":null,"abstract":"<p><p>Although obesity has been associated with better overall survival (OS) among patients with metastatic castration-resistant prostate cancer, its association with OS has not been extensively explored in metastatic hormone-sensitive prostate cancer (mHSPC). We conducted a post hoc exploratory analysis of patient-level data from the SWOG-1216 trial to determine whether baseline body mass index (BMI) is associated with better OS among patients with mHSPC. SWOG-1216 was an open-label, phase 3 trial that randomized patients newly diagnosed with mHSPC 1:1 to either androgen deprivation therapy (ADT) with orteronel (experimental arm) or ADT with bicalutamide (control arm). Of 1279 patients included in the analysis, 12 (0.9%) were underweight, 252 (19.7%) had normal BMI, 958 (74.9%) were overweight, and 57 (4.5%) were obese. Age, Gleason score, extent of disease burden, the incidence of visceral metastases, and treatment allocation were similar among the groups (p > 0.05), while differences in baseline prostate-specific antigen and Zubrod performance status were observed (p < 0.05). Median OS was 2.4, 5.5, 6.6, and 6.8 yr in the underweight, normal, overweight, and obese groups, respectively. After adjusting for prognostic variables, high BMI was associated with better OS (HR for each increment in BMI category: 0.829, 5% CI 0.68-0.98; p = 0.029). These findings need to be validated in other phase 3 trials. PATIENT SUMMARY: We analyzed data from a clinical trial to evaluate the association between body mass index (BMI) and overall survival among patients with metastatic hormone-sensitive prostate cancer. We found that in this group of patients, the risk of death was lower for patients with higher BMI.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment Response Assessment According to Updated PROMISE Criteria in Patients with Metastatic Prostate Cancer Using an Automated Imaging Platform for Identification, Measurement, and Temporal Tracking of Disease. 根据最新的 PROMISE 标准,利用自动成像平台对转移性前列腺癌患者的治疗反应进行评估,以确定、测量和追踪疾病的时间。
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-08 DOI: 10.1016/j.euo.2024.10.011
Cecil M Benitez, Hannicka Sahlstedt, Ida Sonni, Johan Brynolfsson, Gholam Reza Berenji, Jesus Eduardo Juarez, Nathanael Kane, Sonny Tsai, Matthew Rettig, Nicholas George Nickols, Sai Duriseti

Background and objective: Prostate-specific membrane antigen (PSMA) molecular imaging is widely used for disease assessment in prostate cancer (PC). Artificial intelligence (AI) platforms such as automated Prostate Cancer Molecular Imaging Standardized Evaluation (aPROMISE) identify and quantify locoregional and distant disease, thereby expediting lesion identification and standardizing reporting. Our aim was to evaluate the ability of the updated aPROMISE platform to assess treatment responses based on integration of the RECIP (Response Evaluation Criteria in PSMA positron emission tomography-computed tomography [PET/CT]) 1.0 classification.

Methods: The study included 33 patients with castration-sensitive PC (CSPC) and 34 with castration-resistant PC (CRPC) who underwent PSMA-targeted molecular imaging before and ≥2 mo after completion of treatment. Tracer-avid lesions were identified using aPROMISE for pretreatment and post-treatment PET/CT scans. Detected lesions were manually approved by an experienced nuclear medicine physician, and total tumor volume (TTV) was calculated. Response was assessed according to RECIP 1.0 as CR (complete response), PR (partial response), PD (progressive disease), or SD (stable disease). KEY FINDINGS AND LIMITATIONS: aPROMISE identified 1576 lesions on baseline scans and 1631 lesions on follow-up imaging, 618 (35%) of which were new. Of the 67 patients, aPROMISE classified four as CR, 16 as PR, 34 as SD, and 13 as PD; five cases were misclassified. The agreement between aPROMISE and clinician validation was 89.6% (κ = 0.79).

Conclusions and clinical implications: aPROMISE may serve as a novel assessment tool for treatment response that integrates PSMA PET/CT results and RECIP imaging criteria. The precision and accuracy of this automated process should be validated in prospective clinical studies.

Patient summary: We used an artificial intelligence (AI) tool to analyze scans for prostate cancer before and after treatment to see if we could track how cancer spots respond to treatment. We found that the AI approach was successful in tracking individual tumor changes, showing which tumors disappeared, and identifying new tumors in response to prostate cancer treatment.

背景和目的:前列腺特异性膜抗原(PSMA)分子成像被广泛用于前列腺癌(PC)的疾病评估。人工智能(AI)平台,如自动化前列腺癌分子成像标准化评估(aPROMISE),可识别并量化局部和远处疾病,从而加快病灶识别并使报告标准化。我们的目的是评估更新后的 aPROMISE 平台在整合 RECIP(PSMA 正电子发射计算机断层扫描 [PET/CT] 反应评估标准)1.0 分类的基础上评估治疗反应的能力:研究纳入了 33 例阉割敏感 PC (CSPC) 患者和 34 例阉割耐药 PC (CRPC)患者,他们在治疗前和治疗结束后≥2 个月接受了 PSMA 靶向分子成像。使用aPROMISE对治疗前和治疗后的PET/CT扫描进行示踪剂拮抗病变鉴定。检测到的病灶由经验丰富的核医学医生手动核准,并计算肿瘤总体积(TTV)。根据 RECIP 1.0 将反应评估为 CR(完全反应)、PR(部分反应)、PD(疾病进展)或 SD(疾病稳定)。主要发现和局限性:aPROMISE 在基线扫描中发现了 1576 个病灶,在随访成像中发现了 1631 个病灶,其中 618 个(35%)是新病灶。在 67 例患者中,aPROMISE 将 4 例归类为 CR,16 例归类为 PR,34 例归类为 SD,13 例归类为 PD;5 例被误诊。aPROMISE与临床医生验证的一致性为89.6%(κ = 0.79)。结论和临床意义:aPROMISE可作为一种新型的治疗反应评估工具,将PSMA PET/CT结果和RECIP成像标准整合在一起。患者总结:我们使用了一种人工智能(AI)工具来分析前列腺癌治疗前后的扫描结果,以了解我们能否追踪癌点对治疗的反应。我们发现,人工智能方法能够成功追踪单个肿瘤的变化,显示哪些肿瘤消失了,并识别出新肿瘤对前列腺癌治疗的反应。
{"title":"Treatment Response Assessment According to Updated PROMISE Criteria in Patients with Metastatic Prostate Cancer Using an Automated Imaging Platform for Identification, Measurement, and Temporal Tracking of Disease.","authors":"Cecil M Benitez, Hannicka Sahlstedt, Ida Sonni, Johan Brynolfsson, Gholam Reza Berenji, Jesus Eduardo Juarez, Nathanael Kane, Sonny Tsai, Matthew Rettig, Nicholas George Nickols, Sai Duriseti","doi":"10.1016/j.euo.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.euo.2024.10.011","url":null,"abstract":"<p><strong>Background and objective: </strong>Prostate-specific membrane antigen (PSMA) molecular imaging is widely used for disease assessment in prostate cancer (PC). Artificial intelligence (AI) platforms such as automated Prostate Cancer Molecular Imaging Standardized Evaluation (aPROMISE) identify and quantify locoregional and distant disease, thereby expediting lesion identification and standardizing reporting. Our aim was to evaluate the ability of the updated aPROMISE platform to assess treatment responses based on integration of the RECIP (Response Evaluation Criteria in PSMA positron emission tomography-computed tomography [PET/CT]) 1.0 classification.</p><p><strong>Methods: </strong>The study included 33 patients with castration-sensitive PC (CSPC) and 34 with castration-resistant PC (CRPC) who underwent PSMA-targeted molecular imaging before and ≥2 mo after completion of treatment. Tracer-avid lesions were identified using aPROMISE for pretreatment and post-treatment PET/CT scans. Detected lesions were manually approved by an experienced nuclear medicine physician, and total tumor volume (TTV) was calculated. Response was assessed according to RECIP 1.0 as CR (complete response), PR (partial response), PD (progressive disease), or SD (stable disease). KEY FINDINGS AND LIMITATIONS: aPROMISE identified 1576 lesions on baseline scans and 1631 lesions on follow-up imaging, 618 (35%) of which were new. Of the 67 patients, aPROMISE classified four as CR, 16 as PR, 34 as SD, and 13 as PD; five cases were misclassified. The agreement between aPROMISE and clinician validation was 89.6% (κ = 0.79).</p><p><strong>Conclusions and clinical implications: </strong>aPROMISE may serve as a novel assessment tool for treatment response that integrates PSMA PET/CT results and RECIP imaging criteria. The precision and accuracy of this automated process should be validated in prospective clinical studies.</p><p><strong>Patient summary: </strong>We used an artificial intelligence (AI) tool to analyze scans for prostate cancer before and after treatment to see if we could track how cancer spots respond to treatment. We found that the AI approach was successful in tracking individual tumor changes, showing which tumors disappeared, and identifying new tumors in response to prostate cancer treatment.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Value of Whole-body Magnetic Resonance Imaging Using the MET-RADS-P Criteria for Assessing the Response to Intensified Androgen Deprivation Therapy in Metastatic Hormone-naïve and Castration-resistant Prostate Cancer. 使用 MET-RADS-P 标准评估转移性激素无效和阉割耐药前列腺癌患者对强化雄激素剥夺疗法反应的全身磁共振成像价值
IF 8.3 1区 医学 Q1 ONCOLOGY Pub Date : 2024-11-05 DOI: 10.1016/j.euo.2024.10.009
Julien Van Damme, Bertrand Tombal, Nicolas Michoux, Sandy Van Nieuwenhove, Vassiliki Pasoglou, Perrine Triqueneaux, Anwar R Padhani, Frederic E Lecouvet

Background and objectives: We assessed the agreement between prostate-specific antigen (PSA) and imaging responses using whole-body magnetic resonance imaging (wbMRI). Our aim was to explore the potential prognostic value of PSA and wbMRI responses in metastatic hormone-naïve prostate cancer (mHNPC) and castration-resistant PC (mCRPC).

Methods: wbMRI was prospectively performed in 37 patients with mHNPC and 51 with mCRPC before and after 6-12 mo of androgen deprivation therapy and an androgen receptor pathway inhibitor (ARPI). Imaging responses were defined according to the Metastasis Reporting and Data System for PC (MET-RADS-P) criteria. A PSA response was defined as PSA ≤0.2 ng/ml in mHNPC and a ≥50% decrease from the pretreatment level in mCRPC. Agreement between PSA and wbMRI responses was assessed using Cohen's κ. The association between time to subsequent treatment and overall survival (OS) was analyzed using Cox regression analysis.

Key findings and limitations: Agreement between PSA and wbMRI responses was fair in mHNPC (κ = 0.30) but none to slight in mCRPC (κ = 0.15). In mHNPC, patients with a PSA or wbMRI response were less likely to receive subsequent treatments; wbMRI progression was associated with a significantly higher risk of death (hazard ratio 8.59; p = 0.002). In mCRPC, two-thirds of patients with a PSA response showed progression on wbMRI; neither PSA nor wbMRI progression changed the likelihood of starting a subsequent treatment or the risk of death.

Conclusions and clinical implications: In mHNPC, wbMRI progression was associated with a higher risk of needing subsequent treatment and shorter OS.

Patient summary: We evaluated the agreement between routine PSA (prostate-specific antigen) test results and whole-body MRI (magnetic resonance imaging) scans for assessing the response of metastatic prostate cancer to treatment. There was disagreement between the PSA and MRI results, mainly for patients with cancer that was resistant to hormone-based treatment. Combining PSA with whole-body MRI might provide a more accurate picture of the response of advanced prostate cancer to treatment.

背景和目的:我们评估了前列腺特异性抗原(PSA)与全身磁共振成像(wbMRI)成像反应之间的一致性。方法:在雄激素剥夺疗法和雄激素受体通路抑制剂(ARPI)治疗 6-12 个月之前和之后,对 37 名 mHNPC 患者和 51 名 mCRPC 患者进行了前瞻性的全身磁共振成像(wbMRI)检查。成像反应根据PC转移报告和数据系统(MET-RADS-P)标准进行定义。mHNPC的PSA≤0.2 ng/ml和mCRPC的PSA较治疗前水平下降≥50%即为PSA反应。PSA 和 wbMRI 反应之间的一致性采用 Cohen's κ 进行评估。采用Cox回归分析法分析了后续治疗时间与总生存期(OS)之间的关系:在mHNPC(κ = 0.30)中,PSA和wbMRI反应之间的一致性尚可,但在mCRPC(κ = 0.15)中,两者之间的一致性仅为微弱。在mHNPC中,PSA或wbMRI有反应的患者接受后续治疗的可能性较低;wbMRI进展与显著较高的死亡风险相关(危险比为8.59;p = 0.002)。在mCRPC中,三分之二的PSA反应患者在wbMRI上出现进展;PSA或wbMRI进展均未改变开始后续治疗的可能性或死亡风险:患者摘要:我们评估了常规PSA(前列腺特异性抗原)检测结果与全身MRI(磁共振成像)扫描结果在评估转移性前列腺癌治疗反应方面的一致性。前列腺特异性抗原检测结果与核磁共振成像结果之间存在分歧,主要是对激素治疗产生抗药性的癌症患者。将前列腺特异性抗原(PSA)与全身核磁共振成像(MRI)相结合,可能会更准确地反映晚期前列腺癌患者对治疗的反应。
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European urology oncology
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