European urology oncology最新文献

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.

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.

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.

The recent withdrawal of sacituzumab govitecan for advanced urothelial carcinoma has revealed several implications, including concerns over a lack of remaining effective treatment options, reimbursement, supportive care measures (such as granulocyte-colony stimulating factor), dose reductions, and inconsistencies with related historical regulatory decisions.

Background and objective: It has been shown that androgen receptor pathway inhibitor (ARPIs) treatment for metastatic castration-resistant prostate cancer (mCRPC) improves overall survival rates, but ARPIs appear to be associated with a higher frequency of treatment-related neuroendocrine prostate cancer (t-NEPC). Our aim was to quantify the proportion of prostate adenocarcinoma cases that transition to t-NEPC following ARPI therapy.

Methods: We conducted a comprehensive search of the literature on t-NEPC using databases including MEDLINE and Scopus. Eligible studies reported outcome data for NEPC in patients with prior mCRPC treated with an ARPI. To determine the pooled frequency of neuroendocrine transformation, the Freeman-Tukey variance-stabilizing arcsine transformation was applied to individual frequencies.

Key findings and limitations: Among the 938 patients in eight eligible studies, t-NEPC diagnosis was confirmed in 171 patients, predominantly via pathology. Baseline biopsy verification to ensure the absence of NEPC was performed in most cases. The definition of t-NEPC varied among the studies. Five studies used a morphological definition based on histopathology, and three studies used NEPC biomarker detection on circulating tumor cells. A meta-analysis of aggregate data revealed an overall NEPC frequency following ARPI therapy of 16% (95% confidence interval 9-24%).

Conclusion and clinical implications: ARPI-related NEPC represents a frequently underdiagnosed late complication of mCRPC. Given the absence of biomarkers for diagnosis, routine repeat biopsy at the mCRPC stage should be considered to diagnose t-NEPC transitions.

Categorization of patients according to their characteristics may simplify decision-making, but it fails to account for the continuous nature of risk and individual variability. Artificial intelligence has the ability to handle more complex continuous data for more precise, individualized recommendations, but several challenges must be overcome to unlock this potential.

Background and objective: A standardized intraoperative frozen section analysis of the prostate resection margin adjacent to the neurovascular bundle according to the NeuroSAFE technique is performed to maximize nerve sparing during radical prostatectomy (RP) for prostate cancer (PCa). The aim of this review was to analyze oncological and functional outcomes of NeuroSAFE.

Methods: A systematic search of the Medline, Embase, and Web of Science databases until July 2024 was performed. Studies were eligible if these included men undergoing RP with NeuroSAFE for PCa, and reported on oncological and/or functional outcomes. A cumulative analysis with random-effect models for oncological outcomes was conducted using Review Manager software, together with a narrative analysis of the procedure and functional outcomes.

Key findings and limitations: We analyzed 14 studies with nine distinct patient populations; 7505 out of 15 446 patients underwent NeuroSAFE. The number of nerve-sparing procedures was higher for patients with NeuroSAFE than for controls in all studies. Cumulative analyses showed a statistically significantly lower risk of positive surgical margins (PSMs) in favor of NeuroSAFE (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.51-0.91, I² = 79%) and no difference in 2-yr biochemical recurrence (BCR; OR 0.79, 95% CI 0.53-1.18, I² = 63%). All studies with control groups showed higher potency rates in the NeuroSAFE group; none reported significant difference in continence rates. Adverse events were scarce. Limitations of the studies include a lack of randomization resulting in a selection bias; the overall risk of bias judgment ranged from low to serious.

Conclusions and clinical implications: We present the first systematic review on NeuroSAFE during RP. The level of evidence is weak. The increased rate of nerve-sparing surgery, reduced PSMs, similar BCR, and low adverse event rates imply that NeuroSAFE is an oncologically safe technique. NeuroSAFE seems to improve functional outcomes, especially potency, but results of randomized trials are awaited.

Patient summary: We know that for patients with prostate cancer who undergo an operation to remove the prostate, sparing the nerve bundles next to each side of the prostate improves continence and erectile function. In this literature review, we evaluated a technique (NeuroSAFE) that aids surgeons in deciding whether they can spare these nerve bundles safely while still operating radically, for example, remove all cancer. We found that the technique is oncologically safe. Furthermore, the impact on potency appears promising but needs further study.