European urology oncology最新文献

Renal tumors in horseshoe kidneys (HSKs) present unique surgical challenges because of complex vascular anatomy, limited organ mobility, and the proximity of critical structures. We report a European multicenter case series of 24 patients with HSK tumors who underwent robot-assisted partial nephrectomy that was planned with patient-specific three-dimensional (3D) virtual models. Reconstructions were generated from multiphase computed tomography scans, which allowed detailed vascular mapping and tailored ischemia strategies. The median tumor size was 5.4 cm, with a median of three renal arteries per patient. A clampless approach was achieved in 12 cases (50%), including five with anatomic devascularization via ligation of tumor-specific segmental arteries. When clamping was required (n = 12), the median warm ischemia time was 23 min. There were no conversions to open surgery and no local recurrences. Major complications occurred in two patients (8.3%) and the median decline in estimated glomerular filtration rate was -5.0 ml/min/1.73 m² at last follow-up. Trifecta outcomes (negative surgical margin, no major complications, and renal function ≥90% of the baseline value) were achieved in 50% of cases. This series highlights the role of 3D surgical planning in optimizing vascular control, facilitating nephron-sparing techniques, and preserving renal function in these anatomically highly complex procedures.

Risk-adapted prostate cancer screening is urgently needed to reduce overdiagnosis and overtreatment in the general population while allowing intensified risk adapted early detection in high-risk individuals. Clear eligibility criteria for genetic testing, professional education, and structured early detection programs must be established.

Background and objective: Aggressive-variant prostate cancer (AVPC) is an umbrella term that encompasses clinically defined AVPC (c-AVPC), molecularly defined AVPC (m-AVPC), and treatment-related neuroendocrine PC (t-NEPC), which represent a spectrum of metastatic castration-resistant PC phenotypes with poor clinical outcomes. Despite its clinical relevance, AVPC definitions remain heterogeneous and treatment guidelines are lacking. Our aim was to elucidate AVPC prognosis and treatment responsiveness across definitions.

Methods: We conducted a systematic literature search of PubMed, Embase, and Scopus up to September 15, 2025. Our meta-analysis included studies reporting survival outcomes and treatment responses for patients with AVPC.

Key findings and limitations: From 1518 records, 40 studies (including 10 abstracts) were analyzed. In comparison to non-AVPC, c-AVPC/m-AVPC was associated with shorter progression-free survival (PFS; hazard ratio [HR] 2.72, 95% confidence interval [CI] 1.54-4.81; I² = 0%) and overall survival (OS; HR 2.81, 95% CI 1.87-4.22; I² = 36%). Platinum-based chemotherapy (PBC) outperformed non-platinum regimens, with higher objective response rates in the overall AVPC cohort (46% vs 19%; p < 0.01) and in the c-AVPC/m-AVPC (41% vs 16%; p = 0.04) and t-NEPC (49% vs 22%; p < 0.01) subgroups. In c-AVPC/m-AVPC, PBC was associated with longer PFS (HR 0.39, 95% CI 0.24-0.62; I² = 0%) and OS (HR 0.40, 95% CI 0.23-0.68; I² = 0%) according to evidence from mixed-design studies. For t-NEPC, data were insufficient for meta-analytic comparison of PFS and OS by PBC use.

Conclusions and clinical implications: AVPC encompasses distinct subsets of advanced PC that are associated with higher risk of progression and death on standard PC therapies. Platinum-based chemotherapy was associated with better response rates across AVPC subtypes and appears to confer a survival benefit in c-AVPC and m-AVPC. Future studies should focus on molecularly informed classification frameworks that include genomics, histology, and advanced imaging to optimize patient stratification and guide targeted therapies.