Pub Date : 2025-02-01DOI: 10.1016/j.euo.2024.04.018
Wout Devlies , Geert Silversmit , Filip Ameye , Peter Dekuyper , Thierry Quackels , Thierry Roumeguère , Ben Van Cleynenbreugel , Nancy Van Damme , Frank Claessens , Wouter Everaerts , Steven Joniau , Be-RALP: the Belgian RALP Consortium
Background
Robot-assisted laparoscopic prostatectomy (RALP) is used frequently to treat prostate cancer; yet, prospective data on the quality of life and functional outcomes are lacking.
Objective
To assess the quality of life and functional outcomes after radical prostatectomy in different risk groups with or without adjuvant treatments.
Design, setting, and participants
The Be-RALP database is a prospective multicentre database that covers 9235 RALP cases from 2009 until 2016. Of these 9235 patients, 2336 high-risk prostate cancer patients were matched with low/intermediate-risk prostate cancer patients.
Intervention
Patients were treated with RALP only or followed by radiotherapy and/or hormone treatment.
Outcome measurements and statistical analysis
We used a mixed-model analysis to longitudinally analyse quality of life, urinary function, and erectile function between risk groups with or without additional treatments.
Results and limitations
Risk group was not significant in predicting quality of life, erectile function, or urinary function after RALP. Postoperative treatment (hormone and/or radiotherapy treatment) was significant in predicting International Index of Erectile Function (IIEF-5), sexual activity, and sexual functioning.
Conclusions
Risk group was not linked with clinically relevant declines in functional outcomes after RALP. The observed functional outcomes and quality of life are in favour of considering RALP for high-risk prostate cancer. Postoperative treatment resulted in lower erectile function measures without clinically relevant changes in quality of life and urinary functions. Hormone therapy seems to have the most prominent negative effects on these outcomes.
Patient summary
This study investigated the quality of life, and urinary and erectile function in patients with aggressive and less aggressive prostate cancer after surgery only or in combination with hormones or radiation. We found that quality of life recovers completely, while erectile and urinary function recovers only partially after surgery. Aggressiveness of the disease had a minimal effect on the outcomes; yet, postoperative treatments lowered erectile function further.
{"title":"Functional Outcomes and Quality of Life in High-risk Prostate Cancer Patients Treated by Robot-assisted Radical Prostatectomy with or Without Adjuvant Treatments","authors":"Wout Devlies , Geert Silversmit , Filip Ameye , Peter Dekuyper , Thierry Quackels , Thierry Roumeguère , Ben Van Cleynenbreugel , Nancy Van Damme , Frank Claessens , Wouter Everaerts , Steven Joniau , Be-RALP: the Belgian RALP Consortium","doi":"10.1016/j.euo.2024.04.018","DOIUrl":"10.1016/j.euo.2024.04.018","url":null,"abstract":"<div><h3>Background</h3><div>Robot-assisted laparoscopic prostatectomy (RALP) is used frequently to treat prostate cancer; yet, prospective data on the quality of life and functional outcomes are lacking.</div></div><div><h3>Objective</h3><div>To assess the quality of life and functional outcomes after radical prostatectomy in different risk groups with or without adjuvant treatments.</div></div><div><h3>Design, setting, and participants</h3><div>The Be-RALP database is a prospective multicentre database that covers 9235 RALP cases from 2009 until 2016. Of these 9235 patients, 2336 high-risk prostate cancer patients were matched with low/intermediate-risk prostate cancer patients.</div></div><div><h3>Intervention</h3><div>Patients were treated with RALP only or followed by radiotherapy and/or hormone treatment.</div></div><div><h3>Outcome measurements and statistical analysis</h3><div>We used a mixed-model analysis to longitudinally analyse quality of life, urinary function, and erectile function between risk groups with or without additional treatments.</div></div><div><h3>Results and limitations</h3><div>Risk group was not significant in predicting quality of life, erectile function, or urinary function after RALP. Postoperative treatment (hormone and/or radiotherapy treatment) was significant in predicting International Index of Erectile Function (IIEF-5), sexual activity, and sexual functioning.</div></div><div><h3>Conclusions</h3><div>Risk group was not linked with clinically relevant declines in functional outcomes after RALP. The observed functional outcomes and quality of life are in favour of considering RALP for high-risk prostate cancer. Postoperative treatment resulted in lower erectile function measures without clinically relevant changes in quality of life and urinary functions. Hormone therapy seems to have the most prominent negative effects on these outcomes.</div></div><div><h3>Patient summary</h3><div>This study investigated the quality of life, and urinary and erectile function in patients with aggressive and less aggressive prostate cancer after surgery only or in combination with hormones or radiation. We found that quality of life recovers completely, while erectile and urinary function recovers only partially after surgery. Aggressiveness of the disease had a minimal effect on the outcomes; yet, postoperative treatments lowered erectile function further.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 56-65"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957053","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}
Pub Date : 2025-02-01DOI: 10.1016/j.euo.2024.04.020
Zhouliang Wu , Gangjian Zhao , Zhe Zhang , Chong Shen , Lili Wang , Guoping Xu , Yang Zhao , Rui Liang , Changping Li , Huanhuan Liu , Hongmei Wang , Hua Dong , Huaying Fu , Man Li , Hongjun Li , Yan Zhuang , La Da , Shiwang Huang , Kaipeng Jia , Houyuan Chen , Hailong Hu
Background and objective
Combinations of immune checkpoint inhibitors and nab-paclitaxel have achieved significant therapeutic effects in the treatment of advanced urothelial carcinoma. Our aim was to assess the efficacy and safety of tislelizumab combined with low-dose nab-paclitaxel in patients with muscle-invasive bladder cancer (MIBC).
Methods
TRUCE-01 was a single-arm phase 2 study that included 62 patients with T2-4a N0/X M0 MIBC tumors with predominant urothelial carcinoma histology. Eligible patients received three 21-d cycles of intravenous 200 mg tislelizumab on day 1 plus intravenous 200 mg nab-paclitaxel on day 2, followed by surgical assessment. The primary study endpoint was a clinical complete response (cCR). Treatment-related adverse event (TRAE) profiles were recorded according to Common Terminology Criteria for Adverse Events version 5.0.
Key findings and limitations
The safety analysis included all 62 patients and the efficacy analysis included 48 patients. The primary efficacy endpoint (cCR) was met by 25 patients (52%) patients. Among the 62 patients in the safety analysis, six (9.7%) had grade ≥3 TRAEs.
Conclusions
Tislelizumab combined with low-dose nab-paclitaxel showed promising antitumor effectiveness and was generally well tolerated, which makes it an excellent preoperative therapy option for MIBC.
Patient summary
We found that a combination of the drugs tislelizumab and low-dose nab-paclitaxel had satisfactory efficacy and safety for preoperative treatment of muscle-invasive bladder cancer.
{"title":"Phase 2 Study of Preoperative Tislelizumab in Combination with Low-dose Nab-Paclitaxel in Patients with Muscle-invasive Bladder Cancer","authors":"Zhouliang Wu , Gangjian Zhao , Zhe Zhang , Chong Shen , Lili Wang , Guoping Xu , Yang Zhao , Rui Liang , Changping Li , Huanhuan Liu , Hongmei Wang , Hua Dong , Huaying Fu , Man Li , Hongjun Li , Yan Zhuang , La Da , Shiwang Huang , Kaipeng Jia , Houyuan Chen , Hailong Hu","doi":"10.1016/j.euo.2024.04.020","DOIUrl":"10.1016/j.euo.2024.04.020","url":null,"abstract":"<div><h3>Background and objective</h3><div>Combinations of immune checkpoint inhibitors and nab-paclitaxel have achieved significant therapeutic effects in the treatment of advanced urothelial carcinoma. Our aim was to assess the efficacy and safety of tislelizumab combined with low-dose nab-paclitaxel in patients with muscle-invasive bladder cancer (MIBC).</div></div><div><h3>Methods</h3><div>TRUCE-01 was a single-arm phase 2 study that included 62 patients with T2-4a N0/X M0 MIBC tumors with predominant urothelial carcinoma histology. Eligible patients received three 21-d cycles of intravenous 200 mg tislelizumab on day 1 plus intravenous 200 mg nab-paclitaxel on day 2, followed by surgical assessment. The primary study endpoint was a clinical complete response (cCR). Treatment-related adverse event (TRAE) profiles were recorded according to Common Terminology Criteria for Adverse Events version 5.0.</div></div><div><h3>Key findings and limitations</h3><div>The safety analysis included all 62 patients and the efficacy analysis included 48 patients. The primary efficacy endpoint (cCR) was met by 25 patients (52%) patients. Among the 62 patients in the safety analysis, six (9.7%) had grade ≥3 TRAEs.</div></div><div><h3>Conclusions</h3><div>Tislelizumab combined with low-dose nab-paclitaxel showed promising antitumor effectiveness and was generally well tolerated, which makes it an excellent preoperative therapy option for MIBC.</div></div><div><h3>Patient summary</h3><div>We found that a combination of the drugs tislelizumab and low-dose nab-paclitaxel had satisfactory efficacy and safety for preoperative treatment of muscle-invasive bladder cancer.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 66-72"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.euo.2024.07.011
Stephane Oudard , Yohann Tran , Carole Helissey , Charles Vauchier , Raffaele Ratta , Mostefa Bennamoun , Eric Voog , Ali Hasbini , Antoine Thiery-Vuillemin , Kais Aldabbagh , Carolina Saldana , Emmanuel Sevin , Eric Amela , Gunhild Von Amsberg , Nadine Houede , Dominique Besson , Susan Feyerabend , Martin Boegemann , David Pfister , Martin Schostak , Philippe Barthelemy
Background and objective
The CABASTY study showed that more frequent administration of a lower dose of cabazitaxel (CBZ) reduced toxicity in older men with metastatic castration-resistant prostate cancer (mCRPC), without compromising efficacy. Here, we investigated the impact of a biweekly CBZ schedule on patient-reported pain and health-related quality of life (HRQoL).
Methods
We randomized 196 patients from 25 centers (1:1, stratified by age and G8 score) to the biweekly CBZ16 (CBZ 16 mg/m2) experimental arm or the triweekly CBZ25 (CBZ 25 mg/m2) control arm (CABASTY study, NCT02961257). We assessed pain using the Numeric Pain Rating Scale and HRQoL using the Functional Assessment of Cancer Therapy—Prostate (FACT-P) questionnaire.
Key findings and limitations
A total of 141 patients were available for a pain and 160 for an HRQoL analysis. Median time to pain progression (stratified hazard ratio [HR]: 1.7, confidence interval [CI]: 0.67−4.22, p = 0.3) and median time to first opiate use (stratified HR: 1.05, CI: 0.44−2.55, p = 0.9) did not differ between arms. We did not see a significant difference in median time to deterioration of FACT-P total score between treatments (stratified HR: 0.88, CI: 0.47−1.7, p = 0.7). Interestingly, the time to onset of several adverse events was significantly longer in the biweekly CBZ16 group.
Conclusions and clinical implications
HRQoL did not significantly differ between the biweekly CBZ16 and the standard schedule. Additionally, onset of some adverse events was delayed. These results may increase health care providers’ confidence in using CBZ in older patients with mCRPC who are denied chemotherapy.
Patient summary
Androgen receptor pathway inhibitors are often preferred to taxane chemotherapy as a treatment of second or subsequent line in older metastatic castration-resistant prostate cancer patients due to more frequent treatment-related toxicities. Here, we showed that quality of life and pain did not differ significantly with an adapted schedule of cabazitaxel (CBZ), compared with the standard regimen. This CBZ schedule could increase eligibility of older patients for chemotherapy.
{"title":"Pain and Health-related Quality of Life with Biweekly Versus Triweekly Cabazitaxel Schedule in Older Men with Metastatic Castration-resistant Prostate Cancer in the Multicenter, Randomized CABASTY Trial","authors":"Stephane Oudard , Yohann Tran , Carole Helissey , Charles Vauchier , Raffaele Ratta , Mostefa Bennamoun , Eric Voog , Ali Hasbini , Antoine Thiery-Vuillemin , Kais Aldabbagh , Carolina Saldana , Emmanuel Sevin , Eric Amela , Gunhild Von Amsberg , Nadine Houede , Dominique Besson , Susan Feyerabend , Martin Boegemann , David Pfister , Martin Schostak , Philippe Barthelemy","doi":"10.1016/j.euo.2024.07.011","DOIUrl":"10.1016/j.euo.2024.07.011","url":null,"abstract":"<div><h3>Background and objective</h3><div>The CABASTY study showed that more frequent administration of a lower dose of cabazitaxel (CBZ) reduced toxicity in older men with metastatic castration-resistant prostate cancer (mCRPC), without compromising efficacy. Here, we investigated the impact of a biweekly CBZ schedule on patient-reported pain and health-related quality of life (HRQoL).</div></div><div><h3>Methods</h3><div>We randomized 196 patients from 25 centers (1:1, stratified by age and G8 score) to the biweekly CBZ16 (CBZ 16 mg/m<sup>2</sup>) experimental arm or the triweekly CBZ25 (CBZ 25 mg/m<sup>2</sup>) control arm (CABASTY study, NCT02961257). We assessed pain using the Numeric Pain Rating Scale and HRQoL using the Functional Assessment of Cancer Therapy—Prostate (FACT-P) questionnaire.</div></div><div><h3>Key findings and limitations</h3><div>A total of 141 patients were available for a pain and 160 for an HRQoL analysis. Median time to pain progression (stratified hazard ratio [HR]: 1.7, confidence interval [CI]: 0.67−4.22, <em>p</em> = 0.3) and median time to first opiate use (stratified HR: 1.05, CI: 0.44−2.55, <em>p</em> = 0.9) did not differ between arms. We did not see a significant difference in median time to deterioration of FACT-P total score between treatments (stratified HR: 0.88, CI: 0.47−1.7, <em>p</em> = 0.7). Interestingly, the time to onset of several adverse events was significantly longer in the biweekly CBZ16 group.</div></div><div><h3>Conclusions and clinical implications</h3><div>HRQoL did not significantly differ between the biweekly CBZ16 and the standard schedule. Additionally, onset of some adverse events was delayed. These results may increase health care providers’ confidence in using CBZ in older patients with mCRPC who are denied chemotherapy.</div></div><div><h3>Patient summary</h3><div>Androgen receptor pathway inhibitors are often preferred to taxane chemotherapy as a treatment of second or subsequent line in older metastatic castration-resistant prostate cancer patients due to more frequent treatment-related toxicities. Here, we showed that quality of life and pain did not differ significantly with an adapted schedule of cabazitaxel (CBZ), compared with the standard regimen. This CBZ schedule could increase eligibility of older patients for chemotherapy.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Pages 126-134"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.euo.2024.11.015
Riccardo Leni , Andreas Røder , Hein V. Stroomberg
{"title":"Re: Julien Anract, Clément Klein, Ugo Pinar, Morgan Rouprêt, Nicolas Barry Delongchamps, Grégoire Robert. Incidental Prostate Cancer in Patients Undergoing Surgery for Benign Prostatic Hyperplasia: A Predictive Model. Eur Urol Oncol. 2025;8:145–51","authors":"Riccardo Leni , Andreas Røder , Hein V. Stroomberg","doi":"10.1016/j.euo.2024.11.015","DOIUrl":"10.1016/j.euo.2024.11.015","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 1","pages":"Page 215"},"PeriodicalIF":8.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827315","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}
Pub Date : 2025-01-31DOI: 10.1016/j.euo.2024.12.016
Ignacio Puche-Sanz , Ugo Giovanni Falagario , Giorgio Gandaglia , Veeru Kasivisvanathan , Giancarlo Marra , Young Academic Urologists Prostate Cancer Working Party
{"title":"Re: Evelien J.E. van Altena, Bernard H.E. Jansen, Marieke L. Korbee, et al. Prostate-specific Membrane Antigen Positron Emission Tomography Before Reaching the Phoenix Criteria for Biochemical Recurrence of Prostate Cancer After Radiotherapy: Earlier Detection of Recurrences. Eur Urol Oncol. 2025;8:417–424","authors":"Ignacio Puche-Sanz , Ugo Giovanni Falagario , Giorgio Gandaglia , Veeru Kasivisvanathan , Giancarlo Marra , Young Academic Urologists Prostate Cancer Working Party","doi":"10.1016/j.euo.2024.12.016","DOIUrl":"10.1016/j.euo.2024.12.016","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 2","pages":"Pages 594-595"},"PeriodicalIF":8.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074375","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}
Pub Date : 2025-01-30DOI: 10.1016/j.euo.2025.01.004
Giorgio Gandaglia, Francesco Barletta, Simone Scuderi, Pietro Scilipoti, Pawel Rajwa, Nicolai A Huebner, Juan Gomez Rivas, Laura Ibanez, Timo F W Soeterik, Lorenzo Bianchi, Agostino Mattei, Claudia Kesch, Christopher Darr, Hongqian Guo, Junlong Zhuang, Fabio Zattoni, Wolfgang P Fendler, Giancarlo Marra, Armando Stabile, Daniele Robesti, Daniele Amparore, Steven Joniau, Riccardo Schiavina, Jesus Moreno Sierra, Francesco Porpiglia, Maria Picchio, Arturo Chiti, Alexandre Mottrie, Roderick C N van den Bergh, Shahrokh F Shariat, Francesco Montorsi, Alberto Briganti
Background and objective: Extended pelvic lymph node dissection (ePLND) is recommended in selected radical prostatectomy (RP) prostate cancer (PCa) patients for staging purposes. We aim to externally validate available tools to predict lymph node invasion (LNI) in men with negative preoperative prostate-specific membrane antigen positron emission tomography (miN0).
Methods: Overall, 282 intermediate- to high-risk PCa patients with miN0 disease undergoing RP and ePLND at ten centers between 2016 and 2023 were identified. The Memorial Sloan Kettering Cancer Center (MSKCC); Amsterdam-Brisbane-Sydney; and Briganti 2017, 2019, and 2023 tools predicting LNI were validated externally using calibration plots, C-indexes, and decision-curve analyses to assess calibration, discrimination, and net benefit.
Key findings and limitations: Overall, 36 (13%) patients had LNI. The C-indexes of the MSKCC, Briganti 2017, Briganti 2019, Amsterdam-Brisbane-Sydney, and Briganti 2023 nomograms were 64%, 69%, 72%, 64%, and 77%, respectively. The Briganti 2023 nomogram exhibited higher net benefit than the other available nomograms, and the use of a 5% cutoff would have spared 47% ePLND procedures (vs 14% and 4.3% for the Briganti 2019 and Amsterdam-Brisbane-Sydney nomograms, respectively) at the cost of missing only five (3.8%) LNI cases. Heterogeneity in patient selection and imaging protocols represents the main limitations.
Conclusions and clinical implications: The Briganti 2023 nomogram outperformed other available tools in predicting LNI in men with miN0 PCa. The use of this tool resulted in a considerable number of unnecessary ePLND procedures spared and optimization of ePLND recommendations in a contemporary clinical setting.
{"title":"External Validation of Nomograms for the Identification of Pelvic Nodal Dissection Candidates Among Prostate Cancer Patients with Negative Preoperative Prostate-specific Membrane Antigen Positron Emission Tomography.","authors":"Giorgio Gandaglia, Francesco Barletta, Simone Scuderi, Pietro Scilipoti, Pawel Rajwa, Nicolai A Huebner, Juan Gomez Rivas, Laura Ibanez, Timo F W Soeterik, Lorenzo Bianchi, Agostino Mattei, Claudia Kesch, Christopher Darr, Hongqian Guo, Junlong Zhuang, Fabio Zattoni, Wolfgang P Fendler, Giancarlo Marra, Armando Stabile, Daniele Robesti, Daniele Amparore, Steven Joniau, Riccardo Schiavina, Jesus Moreno Sierra, Francesco Porpiglia, Maria Picchio, Arturo Chiti, Alexandre Mottrie, Roderick C N van den Bergh, Shahrokh F Shariat, Francesco Montorsi, Alberto Briganti","doi":"10.1016/j.euo.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.euo.2025.01.004","url":null,"abstract":"<p><strong>Background and objective: </strong>Extended pelvic lymph node dissection (ePLND) is recommended in selected radical prostatectomy (RP) prostate cancer (PCa) patients for staging purposes. We aim to externally validate available tools to predict lymph node invasion (LNI) in men with negative preoperative prostate-specific membrane antigen positron emission tomography (miN0).</p><p><strong>Methods: </strong>Overall, 282 intermediate- to high-risk PCa patients with miN0 disease undergoing RP and ePLND at ten centers between 2016 and 2023 were identified. The Memorial Sloan Kettering Cancer Center (MSKCC); Amsterdam-Brisbane-Sydney; and Briganti 2017, 2019, and 2023 tools predicting LNI were validated externally using calibration plots, C-indexes, and decision-curve analyses to assess calibration, discrimination, and net benefit.</p><p><strong>Key findings and limitations: </strong>Overall, 36 (13%) patients had LNI. The C-indexes of the MSKCC, Briganti 2017, Briganti 2019, Amsterdam-Brisbane-Sydney, and Briganti 2023 nomograms were 64%, 69%, 72%, 64%, and 77%, respectively. The Briganti 2023 nomogram exhibited higher net benefit than the other available nomograms, and the use of a 5% cutoff would have spared 47% ePLND procedures (vs 14% and 4.3% for the Briganti 2019 and Amsterdam-Brisbane-Sydney nomograms, respectively) at the cost of missing only five (3.8%) LNI cases. Heterogeneity in patient selection and imaging protocols represents the main limitations.</p><p><strong>Conclusions and clinical implications: </strong>The Briganti 2023 nomogram outperformed other available tools in predicting LNI in men with miN0 PCa. The use of this tool resulted in a considerable number of unnecessary ePLND procedures spared and optimization of ePLND recommendations in a contemporary clinical setting.</p>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074417","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}
Pub Date : 2025-01-28DOI: 10.1016/j.euo.2024.12.013
Chris Ho-Ming Wong , Ivan Ching-Ho Ko , David Ka-Wai Leung , Steffi Kar-Kei Yuen , Brian Siu , Yuhong Yuan , Alison Birtle , Otakar Capoun , Eva Compérat , José L. Domínguez-Escrig , Fredrik Liedberg , Paramananthan Mariappan , Marco Moschini , Benjamin Pradere , Bhavan P. Rai , Bas W.G. van Rhijn , Thomas Seisen , Shahrokh F. Shariat , Francesco Soria , Viktor Soukup , Jeremy Yuen-Chun Teoh
Background and objective
Bacillus Calmette-Guérin (BCG) reduces disease recurrence and progression in intermediate- and high-risk non–muscle-invasive bladder cancer (NMIBC). BCG-associated adverse events during instillations are common, leading to treatment cessation. Prophylactic use of quinolones in conjunction with BCG instillations is one approach for reducing BCG-associated adverse events. Our aim was to delineate the clinical impact of quinolone prophylaxis (QP) in patients receiving adjuvant BCG instillations for NMIBC.
Methods
In October 2024, a systematic search of MEDLINE, Embase, and the Cochrane Central Register of controlled trials was performed. Prospective and retrospective studies reporting comparative outcomes for patients with and without QP during BCG instillations were included. Outcomes were reported in a binary fashion. Random-effects meta-analysis using the weighted mean difference was conducted. Primary outcomes for pooled analyses included BCG-associated toxicities, the completion rate for BCG induction, the likelihood of antituberculosis treatment, and disease recurrence and progression at 12 mo.
Key findings and limitations
The systematic review included five studies. Four randomised controlled trials were included in the meta-analysis, and one nonrandomised study was also included in the narrative review. The studies involved 445 patients, of whom 194 received QP + BCG and 251 received BCG alone. QP use was associated with lower incidence of class ≥2 (40.8% vs 54.7%; relative risk [RR] 0.79, 95% confidence interval [CI] 0.67–0.94; p = 0.006), and class ≥3 BCG-associated toxicities (25.3% vs 36.4%; RR 0.70, 95% CI 0.50–0.98; p = 0.04) and a higher completion rate for BCG induction (83.0% vs 70.6%; RR 1.16, 95% CI 1.01–1.34; p = 0.04). The 12-mo recurrence rates (14.7% vs 19.4%; RR 0.76, 95% CI 0.46–1.27; p = 0.3) and progression rates (4.5% vs 6.4%; RR 0.86, 95% CI 0.09–8.25; p = 0.9) did not significantly differ for QP + BCG versus BCG alone.
Conclusions and clinical implications
The use of QP with adjuvant BCG for NMIBC mitigated debilitating BCG-associated toxicities and improved the completion rate for BCG induction therapy.
{"title":"A Systematic Review and Meta-analysis of the Clinical Impact of Prophylactic Quinolones with Adjuvant Bacillus Calmette-Guérin Instillation for Non–muscle-invasive Bladder Cancer","authors":"Chris Ho-Ming Wong , Ivan Ching-Ho Ko , David Ka-Wai Leung , Steffi Kar-Kei Yuen , Brian Siu , Yuhong Yuan , Alison Birtle , Otakar Capoun , Eva Compérat , José L. Domínguez-Escrig , Fredrik Liedberg , Paramananthan Mariappan , Marco Moschini , Benjamin Pradere , Bhavan P. Rai , Bas W.G. van Rhijn , Thomas Seisen , Shahrokh F. Shariat , Francesco Soria , Viktor Soukup , Jeremy Yuen-Chun Teoh","doi":"10.1016/j.euo.2024.12.013","DOIUrl":"10.1016/j.euo.2024.12.013","url":null,"abstract":"<div><h3>Background and objective</h3><div>Bacillus Calmette-Guérin (BCG) reduces disease recurrence and progression in intermediate- and high-risk non–muscle-invasive bladder cancer (NMIBC). BCG-associated adverse events during instillations are common, leading to treatment cessation. Prophylactic use of quinolones in conjunction with BCG instillations is one approach for reducing BCG-associated adverse events. Our aim was to delineate the clinical impact of quinolone prophylaxis (QP) in patients receiving adjuvant BCG instillations for NMIBC.</div></div><div><h3>Methods</h3><div>In October 2024, a systematic search of MEDLINE, Embase, and the Cochrane Central Register of controlled trials was performed. Prospective and retrospective studies reporting comparative outcomes for patients with and without QP during BCG instillations were included. Outcomes were reported in a binary fashion. Random-effects meta-analysis using the weighted mean difference was conducted. Primary outcomes for pooled analyses included BCG-associated toxicities, the completion rate for BCG induction, the likelihood of antituberculosis treatment, and disease recurrence and progression at 12 mo.</div></div><div><h3>Key findings and limitations</h3><div>The systematic review included five studies. Four randomised controlled trials were included in the meta-analysis, and one nonrandomised study was also included in the narrative review. The studies involved 445 patients, of whom 194 received QP + BCG and 251 received BCG alone. QP use was associated with lower incidence of class ≥2 (40.8% vs 54.7%; relative risk [RR] 0.79, 95% confidence interval [CI] 0.67–0.94; <em>p</em> = 0.006), and class ≥3 BCG-associated toxicities (25.3% vs 36.4%; RR 0.70, 95% CI 0.50–0.98; <em>p</em> = 0.04) and a higher completion rate for BCG induction (83.0% vs 70.6%; RR 1.16, 95% CI 1.01–1.34; <em>p</em> = 0.04). The 12-mo recurrence rates (14.7% vs 19.4%; RR 0.76, 95% CI 0.46–1.27; <em>p</em> = 0.3) and progression rates (4.5% vs 6.4%; RR 0.86, 95% CI 0.09–8.25; <em>p</em> = 0.9) did not significantly differ for QP + BCG versus BCG alone.</div></div><div><h3>Conclusions and clinical implications</h3><div>The use of QP with adjuvant BCG for NMIBC mitigated debilitating BCG-associated toxicities and improved the completion rate for BCG induction therapy.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 2","pages":"Pages 571-580"},"PeriodicalIF":8.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064592","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}
Pub Date : 2025-01-28DOI: 10.1016/j.euo.2024.12.012
Mirabela Rusu , Hassan Jahanandish , Sulaiman Vesal , Cynthia Xinran Li , Indrani Bhattacharya , Rajesh Venkataraman , Steve Ran Zhou , Zachary Kornberg , Elijah Richard Sommer , Yash Samir Khandwala , Luke Hockman , Zhien Zhou , Moon Hyung Choi , Pejman Ghanouni , Richard E. Fan , Geoffrey A. Sonn
Background and objective
To assess whether conventional brightness-mode (B-mode) transrectal ultrasound images of the prostate reveal clinically significant cancers with the help of artificial intelligence methods.
Methods
This study included 2986 men who underwent biopsies at two institutions. We trained the PROstate Cancer detection on B-mode transrectal UltraSound images NETwork (ProCUSNet) to determine whether ultrasound can reliably detect cancer. Specifically, ProCUSNet is based on the well-established nnUNet frameworks, and seeks to detect and outline clinically significant cancer on three-dimensional (3D) examinations reconstructed from 2D screen captures. We compared ProCUSNet against (1) reference labels (n = 515 patients), (2) eight readers that interpreted B-mode ultrasound (n = 20–80 patients), and (3) radiologists interpreting magnetic resonance imaging (MRI) for clinical care (n = 110 radical prostatectomy patients).
Key findings and limitations
ProCUSNet found 82% clinically significant cancer cases with a lesion boundary error of up to 2.67 mm and detected 42% more lesions than ultrasound readers (sensitivity: 0.86 vs 0.44, p < 0.05, Wilcoxon test, Bonferroni correction). Furthermore, ProCUSNet has similar performance to radiologists interpreting MRI when accounting for registration errors (sensitivity: 0.79 vs 0.78, p > 0.05, Wilcoxon test, Bonferroni correction), while having the same targeting utility as a supplement to systematic biopsies.
Conclusions and clinical implications
ProCUSNet can localize clinically significant cancer on screen capture B-mode ultrasound, a task that is particularly challenging for clinicians reading these examinations. As a supplement to systematic biopsies, ProCUSNet appears comparable with MRI, suggesting its utility for targeting suspicious lesions during the biopsy and possibly for screening using ultrasound alone, in the absence of MRI.
{"title":"ProCUSNet: Prostate Cancer Detection on B-mode Transrectal Ultrasound Using Artificial Intelligence for Targeting During Prostate Biopsies","authors":"Mirabela Rusu , Hassan Jahanandish , Sulaiman Vesal , Cynthia Xinran Li , Indrani Bhattacharya , Rajesh Venkataraman , Steve Ran Zhou , Zachary Kornberg , Elijah Richard Sommer , Yash Samir Khandwala , Luke Hockman , Zhien Zhou , Moon Hyung Choi , Pejman Ghanouni , Richard E. Fan , Geoffrey A. Sonn","doi":"10.1016/j.euo.2024.12.012","DOIUrl":"10.1016/j.euo.2024.12.012","url":null,"abstract":"<div><h3>Background and objective</h3><div>To assess whether conventional brightness-mode (B-mode) transrectal ultrasound images of the prostate reveal clinically significant cancers with the help of artificial intelligence methods.</div></div><div><h3>Methods</h3><div>This study included 2986 men who underwent biopsies at two institutions. We trained the PROstate Cancer detection on B-mode transrectal UltraSound images NETwork (ProCUSNet) to determine whether ultrasound can reliably detect cancer. Specifically, ProCUSNet is based on the well-established nnUNet frameworks, and seeks to detect and outline clinically significant cancer on three-dimensional (3D) examinations reconstructed from 2D screen captures. We compared ProCUSNet against (1) reference labels (<em>n</em> = 515 patients), (2) eight readers that interpreted B-mode ultrasound (<em>n</em> = 20–80 patients), and (3) radiologists interpreting magnetic resonance imaging (MRI) for clinical care (<em>n</em> = 110 radical prostatectomy patients).</div></div><div><h3>Key findings and limitations</h3><div>ProCUSNet found 82% clinically significant cancer cases with a lesion boundary error of up to 2.67 mm and detected 42% more lesions than ultrasound readers (sensitivity: 0.86 vs 0.44, <em>p</em> < 0.05, Wilcoxon test, Bonferroni correction). Furthermore, ProCUSNet has similar performance to radiologists interpreting MRI when accounting for registration errors (sensitivity: 0.79 vs 0.78, <em>p</em> > 0.05, Wilcoxon test, Bonferroni correction), while having the same targeting utility as a supplement to systematic biopsies.</div></div><div><h3>Conclusions and clinical implications</h3><div>ProCUSNet can localize clinically significant cancer on screen capture B-mode ultrasound, a task that is particularly challenging for clinicians reading these examinations. As a supplement to systematic biopsies, ProCUSNet appears comparable with MRI, suggesting its utility for targeting suspicious lesions during the biopsy and possibly for screening using ultrasound alone, in the absence of MRI.</div></div>","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 2","pages":"Pages 477-485"},"PeriodicalIF":8.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064683","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}
Pub Date : 2025-01-23DOI: 10.1016/j.euo.2025.01.003
David J. Benjamin , Arash Rezazadeh Kalebasty , Nataliya Mar
{"title":"Implications and Lessons from the Withdrawal of Sacituzumab Govitecan for Treating Advanced Urothelial Carcinoma","authors":"David J. Benjamin , Arash Rezazadeh Kalebasty , Nataliya Mar","doi":"10.1016/j.euo.2025.01.003","DOIUrl":"10.1016/j.euo.2025.01.003","url":null,"abstract":"","PeriodicalId":12256,"journal":{"name":"European urology oncology","volume":"8 2","pages":"Pages 242-244"},"PeriodicalIF":8.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037756","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}
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