Pub Date : 2023-11-30DOI: 10.22465/juo.234600540027
Hye-Mi Ha, Joo Han Lim
Renal cell carcinoma (RCC) remains a significant challenge in oncology, prompting thorough investigations into adjuvant treatments aimed at enhancing both survival and quality of life for patients. In this review, we explore the complex landscape of adjuvant treatments for managing RCC, highlighting the pivotal roles and efficacy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). This review article presents a detailed exploration of both historical and contemporary trials involving TKIs, spotlighting their capabilities, successes, and limitations in the adjuvant setting. Furthermore, we examine the emerging significance of ICIs, analyzing recent trials and assessing their impact on outcomes such as disease-free survival and overall survival. Additionally, this review provides insights into the application, adaptation, and outcomes of these adjuvant therapies within the specific context and circumstances of Korean healthcare.
{"title":"The Future of Adjuvant Therapy in Renal Cell Carcinoma: Recent Insights and Prospects","authors":"Hye-Mi Ha, Joo Han Lim","doi":"10.22465/juo.234600540027","DOIUrl":"https://doi.org/10.22465/juo.234600540027","url":null,"abstract":"Renal cell carcinoma (RCC) remains a significant challenge in oncology, prompting thorough investigations into adjuvant treatments aimed at enhancing both survival and quality of life for patients. In this review, we explore the complex landscape of adjuvant treatments for managing RCC, highlighting the pivotal roles and efficacy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs). This review article presents a detailed exploration of both historical and contemporary trials involving TKIs, spotlighting their capabilities, successes, and limitations in the adjuvant setting. Furthermore, we examine the emerging significance of ICIs, analyzing recent trials and assessing their impact on outcomes such as disease-free survival and overall survival. Additionally, this review provides insights into the application, adaptation, and outcomes of these adjuvant therapies within the specific context and circumstances of Korean healthcare.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139208155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.22465/juo.234600340017
Hyunho Han, Minyong Kang, S. Byun, S. Yun
As genetic testing plays an increasingly salient role in the realm of cancer diagnosis, prognostication, and treatment, this review aims to elucidate the current landscape and future directions of genetic testing in genitourinary cancers, with a focus on prostate cancer, urothelial carcinoma, and renal cell carcinoma. With the increasing adoption of next-generation sequencing technology, the utilization and access to genetic testing in real-world settings have become critical for practicing urologists and genitourinary oncologists, especially after the approval of poly(ADP-ribose) polymerase inhibitors for prostate cancer and the utilization of immune checkpoint inhibitors. In this rapidly evolving field, this review underscores the clinical value of interpreting genetic variations and the importance of distinguishing between germline and somatic mutations, for whom testing can be prescribed, and which genes should be tested. While the current modus operandi predominantly relies on exome sequencing, we posit that the future of genetic testing in genitourinary cancers will see an expansion to encompass whole-genome sequencing, accounting for structural and regulatory variations that impact gene expression. In the upcoming era of liquid biopsies, we envisage an increase in noninvasive cancer genetic testing for the purposes of diagnosis, prognosis, treatment response, and progression monitoring, supplementing the gold-standard tissue biopsies that provide histologic information. Ultimately, thoroughly interpreting genetic testing results and the subsequent treatment implications necessitates a multidisciplinary approach. This review strives to offer urologists a comprehensive perspective on genetic testing in these prevalent urological cancers, contributing to improved diagnosis, prognosis, and treatment decision-making.
{"title":"Genetic Testing for Prostate Cancer, Urothelial Cancer, and Kidney Cancer","authors":"Hyunho Han, Minyong Kang, S. Byun, S. Yun","doi":"10.22465/juo.234600340017","DOIUrl":"https://doi.org/10.22465/juo.234600340017","url":null,"abstract":"As genetic testing plays an increasingly salient role in the realm of cancer diagnosis, prognostication, and treatment, this review aims to elucidate the current landscape and future directions of genetic testing in genitourinary cancers, with a focus on prostate cancer, urothelial carcinoma, and renal cell carcinoma. With the increasing adoption of next-generation sequencing technology, the utilization and access to genetic testing in real-world settings have become critical for practicing urologists and genitourinary oncologists, especially after the approval of poly(ADP-ribose) polymerase inhibitors for prostate cancer and the utilization of immune checkpoint inhibitors. In this rapidly evolving field, this review underscores the clinical value of interpreting genetic variations and the importance of distinguishing between germline and somatic mutations, for whom testing can be prescribed, and which genes should be tested. While the current modus operandi predominantly relies on exome sequencing, we posit that the future of genetic testing in genitourinary cancers will see an expansion to encompass whole-genome sequencing, accounting for structural and regulatory variations that impact gene expression. In the upcoming era of liquid biopsies, we envisage an increase in noninvasive cancer genetic testing for the purposes of diagnosis, prognosis, treatment response, and progression monitoring, supplementing the gold-standard tissue biopsies that provide histologic information. Ultimately, thoroughly interpreting genetic testing results and the subsequent treatment implications necessitates a multidisciplinary approach. This review strives to offer urologists a comprehensive perspective on genetic testing in these prevalent urological cancers, contributing to improved diagnosis, prognosis, and treatment decision-making.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"182 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121180221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.22465/juo.234600300015
S. Song, J. Oh
Traditional cisplatin-based chemotherapy has long been the mainstay treatment for advanced urothelial carcinoma (UC), but the emergence of immune checkpoint inhibitors (ICIs) and immunotherapy has revolutionized the field. ICIs, which target crucial immune proteins such as programmed cell death protein 1 (PD-1) and its ligand (PD-L1), enhance T-cell-mediated antitumor responses and have shown sustained responses not only in adjuvant settings but also in neoadjuvant and maintenance contexts. The introduction of newer agents like nivolumab and atezolizumab has broadened the use of ICIs, resulting in encouraging results in clinical trials for UC. This review offers a concise summary of key studies across various clinical stages and highlights ongoing clinical trials that could potentially impact UC treatment.
{"title":"The Evolving Role of Checkpoint Inhibitors in the Treatment of Urothelial Carcinoma: A Literature Review of Practice-Changing Trials","authors":"S. Song, J. Oh","doi":"10.22465/juo.234600300015","DOIUrl":"https://doi.org/10.22465/juo.234600300015","url":null,"abstract":"Traditional cisplatin-based chemotherapy has long been the mainstay treatment for advanced urothelial carcinoma (UC), but the emergence of immune checkpoint inhibitors (ICIs) and immunotherapy has revolutionized the field. ICIs, which target crucial immune proteins such as programmed cell death protein 1 (PD-1) and its ligand (PD-L1), enhance T-cell-mediated antitumor responses and have shown sustained responses not only in adjuvant settings but also in neoadjuvant and maintenance contexts. The introduction of newer agents like nivolumab and atezolizumab has broadened the use of ICIs, resulting in encouraging results in clinical trials for UC. This review offers a concise summary of key studies across various clinical stages and highlights ongoing clinical trials that could potentially impact UC treatment.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115513095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prostate cancer is a severe health problem worldwide, and timely and accurate diagnosis is essential for effective treatment planning. In recent years, multiparametric magnetic resonance imaging (mpMRI) has emerged as a powerful noninvasive tool in detecting and characterizing prostate cancer. The clinical application of mpMRI has changed the diagnostic landscape, allowing for improved risk stratification and guided targeted biopsies. Professor Chang Wook Jeong [1] contributed a review article that provides a comprehensive analysis of the use of magnetic resonance imaging (MRI) and fusion biopsy in the context of active surveillance for prostate cancer. Professor Byung Kwan Park [2] drew on his extensive experience to point out the limitations of the current PI-RADS (Prostate Imaging and Reporting and Data System) version 2.1. Professors Jun Nyung Lee and Tae Gyun Kwon [3] authored an original paper presenting an innovative study on the importance of multivariate MRI in predicting extraprostatic extension in prostate cancer patients. Finally, Professor Kyung Kgi Park [4] offers a cost-benefit comparison of biparametric MRI in a study highlighting the economic implications of using this imaging modality in evaluating prostate cancer.
{"title":"This Month’s Issue of JUO","authors":"C. Kwak","doi":"10.22465/juo.23edi003","DOIUrl":"https://doi.org/10.22465/juo.23edi003","url":null,"abstract":"Prostate cancer is a severe health problem worldwide, and timely and accurate diagnosis is essential for effective treatment planning. In recent years, multiparametric magnetic resonance imaging (mpMRI) has emerged as a powerful noninvasive tool in detecting and characterizing prostate cancer. The clinical application of mpMRI has changed the diagnostic landscape, allowing for improved risk stratification and guided targeted biopsies. Professor Chang Wook Jeong [1] contributed a review article that provides a comprehensive analysis of the use of magnetic resonance imaging (MRI) and fusion biopsy in the context of active surveillance for prostate cancer. Professor Byung Kwan Park [2] drew on his extensive experience to point out the limitations of the current PI-RADS (Prostate Imaging and Reporting and Data System) version 2.1. Professors Jun Nyung Lee and Tae Gyun Kwon [3] authored an original paper presenting an innovative study on the importance of multivariate MRI in predicting extraprostatic extension in prostate cancer patients. Finally, Professor Kyung Kgi Park [4] offers a cost-benefit comparison of biparametric MRI in a study highlighting the economic implications of using this imaging modality in evaluating prostate cancer.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115122407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.22465/juo.224400580029
Sung Kyung Choi, Chan Hoon Gwak, J. Suh, B. Lim, Cheryn Song, D. You, I. Jeong, J. Hong, B. Hong, Choung-Soo Kim, H. Ahn
Purpose: This study aims to evaluate the systemic inflammatory response indices (SII) for the prediction of the non–organ-confined (non-OC) disease in upper urinary tract urothelial carcinoma (UTUC) patients.Materials and Methods: From March 2010 to March 2020, patients who underwent radical nephroureterectomy (RNU) in a single tertiary center were retrospectively reviewed. Tumor location, multifocality, hydronephrosis on preoperative imaging, and preoperative SII, including C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (PLR) were used for analysis. Non-OC defined by locally advanced (pT3-4) or node-positive disease (pN1-2) in pathologic examination. Multivariable logistic regression was used for determining independent predictive markers of non-OC disease. Factors associated with locally advanced (pT3-4), and node-positive (pN1-2) disease were also analyzed.Results: Overall, 711 UTUC patients who underwent RNU, without neoadjuvant chemotherapy, were analyzed. The average age was 68.6±9.9 years and 507 patients were male. Non-OC disease was 36.8% (262 of 711); specifically, 35.9% (255 of 711) was locally advanced and 7.2% (51 of 771) was node-positive disease. Multivariable analysis demonstrated hydronephrosis (odds ratio [OR], 1.46; 95%confidence interval [CI], 1.06–2.01; p=0.02), high PLR (OR, 1.45; 95% CI, 1.05–2.01; p=0.03), and high CAR (OR, 2.56; 95% CI, 1.79–3.66; p<0.01) were independent predictive markers non-OC disease. Hydronephrosis (p=0.01), high PLR (p=0.02), and high CAR (p<0.01) were predictive markers for locally advanced disease, and multifocal tumor (p<0.01) and high CAR (p<0.01) were predictive markers for node-positive disease.Conclusions: CAR is a novel important factor for predicting any subtype of non-OC disease among SII. Large scale, multicenter studies should validate the clinical role of CAR.
{"title":"The Predictive Value of the Preoperative Systemic Inflammatory Response Indices in Non–Organ-Confined Disease in Upper Urinary Tract Urothelial Carcinoma","authors":"Sung Kyung Choi, Chan Hoon Gwak, J. Suh, B. Lim, Cheryn Song, D. You, I. Jeong, J. Hong, B. Hong, Choung-Soo Kim, H. Ahn","doi":"10.22465/juo.224400580029","DOIUrl":"https://doi.org/10.22465/juo.224400580029","url":null,"abstract":"Purpose: This study aims to evaluate the systemic inflammatory response indices (SII) for the prediction of the non–organ-confined (non-OC) disease in upper urinary tract urothelial carcinoma (UTUC) patients.Materials and Methods: From March 2010 to March 2020, patients who underwent radical nephroureterectomy (RNU) in a single tertiary center were retrospectively reviewed. Tumor location, multifocality, hydronephrosis on preoperative imaging, and preoperative SII, including C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (PLR) were used for analysis. Non-OC defined by locally advanced (pT3-4) or node-positive disease (pN1-2) in pathologic examination. Multivariable logistic regression was used for determining independent predictive markers of non-OC disease. Factors associated with locally advanced (pT3-4), and node-positive (pN1-2) disease were also analyzed.Results: Overall, 711 UTUC patients who underwent RNU, without neoadjuvant chemotherapy, were analyzed. The average age was 68.6±9.9 years and 507 patients were male. Non-OC disease was 36.8% (262 of 711); specifically, 35.9% (255 of 711) was locally advanced and 7.2% (51 of 771) was node-positive disease. Multivariable analysis demonstrated hydronephrosis (odds ratio [OR], 1.46; 95%confidence interval [CI], 1.06–2.01; p=0.02), high PLR (OR, 1.45; 95% CI, 1.05–2.01; p=0.03), and high CAR (OR, 2.56; 95% CI, 1.79–3.66; p<0.01) were independent predictive markers non-OC disease. Hydronephrosis (p=0.01), high PLR (p=0.02), and high CAR (p<0.01) were predictive markers for locally advanced disease, and multifocal tumor (p<0.01) and high CAR (p<0.01) were predictive markers for node-positive disease.Conclusions: CAR is a novel important factor for predicting any subtype of non-OC disease among SII. Large scale, multicenter studies should validate the clinical role of CAR.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115572990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.22465/juo.234600260013
C. Jeong
This review explores the role of magnetic resonance imaging (MRI) and MRI-targeted biopsies in the selection and monitoring of men with low-risk prostate cancer (PCa) who are on active surveillance (AS). At present, MRI and MRI-targeted biopsies are broadly recommended for the selection and monitoring of men with low-risk PCa on AS. Multiparametric MRI (mpMRI) and MRI-targeted biopsies should be considered for screening, or in the early period following screening, for men who have been enrolled after only a random transrectal ultrasound-guided biopsy in order to reduce initial misclassification. However, a significant number of pathological progressions were diagnosed solely by systematic biopsies. This suggests that systematic biopsy, in conjunction with MRI-targeted biopsy and protocol-based transrectal ultrasound-guided biopsy, should not be omitted when there are no visible lesions on mpMRI. The use of MRI features during AS, particularly the PRECISE (Prostate Cancer Radiological Estimation of Change in Sequential Evaluation) score, appears promising as it offers a more accurate risk restratification during follow-up. Evidence for these changes is awaited from larger, prospective cohorts.
{"title":"The Role of Magnetic Resonance Imaging (MRI) and MRI-Targeted Biopsy for Active Surveillance","authors":"C. Jeong","doi":"10.22465/juo.234600260013","DOIUrl":"https://doi.org/10.22465/juo.234600260013","url":null,"abstract":"This review explores the role of magnetic resonance imaging (MRI) and MRI-targeted biopsies in the selection and monitoring of men with low-risk prostate cancer (PCa) who are on active surveillance (AS). At present, MRI and MRI-targeted biopsies are broadly recommended for the selection and monitoring of men with low-risk PCa on AS. Multiparametric MRI (mpMRI) and MRI-targeted biopsies should be considered for screening, or in the early period following screening, for men who have been enrolled after only a random transrectal ultrasound-guided biopsy in order to reduce initial misclassification. However, a significant number of pathological progressions were diagnosed solely by systematic biopsies. This suggests that systematic biopsy, in conjunction with MRI-targeted biopsy and protocol-based transrectal ultrasound-guided biopsy, should not be omitted when there are no visible lesions on mpMRI. The use of MRI features during AS, particularly the PRECISE (Prostate Cancer Radiological Estimation of Change in Sequential Evaluation) score, appears promising as it offers a more accurate risk restratification during follow-up. Evidence for these changes is awaited from larger, prospective cohorts.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"351 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122838071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.22465/juo.234600320016
B. K. Park
The Prostate Imaging and Reporting and Data System version 2.1 (PI-RADSv2.1) is commonly utilized in interpreting magnetic resonance imaging (MRI) scans in men with elevated prostate-specific antigen levels. This system aids in the risk stratification of prostate cancer and facilitates communication between radiologists and urologists. However, the current PI-RADSv2.1 decision rules present several pitfalls, particularly in relation to definitions, categorizations, MRI sequences, MRI protocols, and MRI interpretations. There are few reports addressing these limitations. The aim of this review is to outline the pitfalls encountered when applying PI-RADSv2.1.
{"title":"Prostate Imaging and Reporting and Data System Version 2.1: Limitations for Clinical Use","authors":"B. K. Park","doi":"10.22465/juo.234600320016","DOIUrl":"https://doi.org/10.22465/juo.234600320016","url":null,"abstract":"The Prostate Imaging and Reporting and Data System version 2.1 (PI-RADSv2.1) is commonly utilized in interpreting magnetic resonance imaging (MRI) scans in men with elevated prostate-specific antigen levels. This system aids in the risk stratification of prostate cancer and facilitates communication between radiologists and urologists. However, the current PI-RADSv2.1 decision rules present several pitfalls, particularly in relation to definitions, categorizations, MRI sequences, MRI protocols, and MRI interpretations. There are few reports addressing these limitations. The aim of this review is to outline the pitfalls encountered when applying PI-RADSv2.1.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115236734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.22465/juo.224400600030
J. Huh, K. Park
Purpose: : This study aimed to compare the cost-effectiveness and feasibility of biparametric magnetic resonance imaging (bp MRI) for prostate cancer screening to prostate-specific antigen (PSA)-based screening.Materials and Methods: We retrospectively reviewed the data from 602 men who had PSA-based prostate cancer screening between July 2014 and April 2017 and 621 men who underwent bp MRI-based prostate cancer screening between May 2017 and December 2020. Of them, 467 men with Prostate Imaging Reporting and Data System scores of 3 or higher underwent magnetic resonance imaging/ultrasound fusion transrectal biopsy and random transrectal prostate biopsy. The remaining 154 patients underwent random prostate biopsies only. Patient demographics, digital rectal examination, staging, PSA level, PSA density, bp MRI findings associated with prostate cancer detection on biopsy, admission rate for complications after prostate biopsy, and associated medical costs were analyzed.Results: Prebiopsy demographics were comparable. The MRI-based screening had a higher prostate cancer detection rate (62.7%) than conventional screening (45.1%). Biparametric MRI was more sensitive for clinically significant prostate cancer (csPCa) (40.6% vs. 23.5%). In 154 men who lacked a targetable prostate lesion, 47 and 14 patients (9.1%) had insignificant and significant prostate cancer, respectively. None of the patients had more than Gleason 8 (4+4). MRI-based screening costs more than conventional screening. However, the cost of detecting csPCa can be reduced by 49.4% (United States dollar [USD] 14,883.5 vs. USD 7,355.0).Conclusions: MRI-based screening is sensitive for csPCa and is cost-effective. It can also reduce unnecessary biopsies to detect insignificant prostate cancer
{"title":"A Cost-Benefit Comparison of Biparametric Magnetic Resonance Imaging Versus Conventional Prostate Cancer Screening","authors":"J. Huh, K. Park","doi":"10.22465/juo.224400600030","DOIUrl":"https://doi.org/10.22465/juo.224400600030","url":null,"abstract":"Purpose: : This study aimed to compare the cost-effectiveness and feasibility of biparametric magnetic resonance imaging (bp MRI) for prostate cancer screening to prostate-specific antigen (PSA)-based screening.Materials and Methods: We retrospectively reviewed the data from 602 men who had PSA-based prostate cancer screening between July 2014 and April 2017 and 621 men who underwent bp MRI-based prostate cancer screening between May 2017 and December 2020. Of them, 467 men with Prostate Imaging Reporting and Data System scores of 3 or higher underwent magnetic resonance imaging/ultrasound fusion transrectal biopsy and random transrectal prostate biopsy. The remaining 154 patients underwent random prostate biopsies only. Patient demographics, digital rectal examination, staging, PSA level, PSA density, bp MRI findings associated with prostate cancer detection on biopsy, admission rate for complications after prostate biopsy, and associated medical costs were analyzed.Results: Prebiopsy demographics were comparable. The MRI-based screening had a higher prostate cancer detection rate (62.7%) than conventional screening (45.1%). Biparametric MRI was more sensitive for clinically significant prostate cancer (csPCa) (40.6% vs. 23.5%). In 154 men who lacked a targetable prostate lesion, 47 and 14 patients (9.1%) had insignificant and significant prostate cancer, respectively. None of the patients had more than Gleason 8 (4+4). MRI-based screening costs more than conventional screening. However, the cost of detecting csPCa can be reduced by 49.4% (United States dollar [USD] 14,883.5 vs. USD 7,355.0).Conclusions: MRI-based screening is sensitive for csPCa and is cost-effective. It can also reduce unnecessary biopsies to detect insignificant prostate cancer","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115563332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.22465/juo.234600160008
J. Kang, Jun-Koo Kang, J. Chung, Y. Ha, S. Choi, B. Kim, H. T. Kim, Tae-Hwan Kim, E. Yoo, See Hyung Kim, G. Yoon, J. N. Lee, T. Kwon
Purpose: The accuracy of extraprostatic extension (EPE) on multiparametric magnetic resonance imaging (mpMRI) for the preoperative staging of prostate cancer (PCa) remains controversial. This study aimed to determine the effect of mpMRI for EPE prediction in the final pathology after radical prostatectomy (RP) according to the National Comprehensive Cancer Network (NCCN) risk stratification in patients with clinically localized PCa.Materials and Methods: This retrospective study analyzed 340 consecutive patients diagnosed with clinically localized PCa who underwent RP with preoperative mpMRI between March 2020 and December 2021. They were stratified according to the NCCN risk stratification into low (LR), favorable intermediate (FIR), unfavorable intermediate (UIR), and high risk (HR) groups to assess final pathological EPE. The accuracy of staging mpMRI was assessed in each group. Univariate and multivariate analyses evaluated the predictors of EPE in the final pathology after RP.Results: Preoperative mpMRI showed suspicious EPE in 87 patients (25.6%), whereas postoperative pathological evaluation revealed EPE in 137 patients (40.3%). The LR group showed relatively low sensitivity and positive predictive value compared with other groups. In the multivariate analysis, suspicious EPE on mpMRI was a significant predictive factor for EPE in the final pathology in the FIR, UIR, and HR groups (p=0.012, p=0.011, and p=0.001, respectively), whereas no correlation was observed in the LR group (p=0.711).Conclusions: A strong correlation was observed between suspicious EPE on mpMRI and EPE in the final pathology in the FIR, UIR, and HR groups but not in the LR group.
{"title":"Impact of Multiparametric Magnetic Resonance Imaging for the Prediction of Extraprostatic Extension According to the National Comprehensive Cancer Network Risk Stratification in Prostate Cancer","authors":"J. Kang, Jun-Koo Kang, J. Chung, Y. Ha, S. Choi, B. Kim, H. T. Kim, Tae-Hwan Kim, E. Yoo, See Hyung Kim, G. Yoon, J. N. Lee, T. Kwon","doi":"10.22465/juo.234600160008","DOIUrl":"https://doi.org/10.22465/juo.234600160008","url":null,"abstract":"Purpose: The accuracy of extraprostatic extension (EPE) on multiparametric magnetic resonance imaging (mpMRI) for the preoperative staging of prostate cancer (PCa) remains controversial. This study aimed to determine the effect of mpMRI for EPE prediction in the final pathology after radical prostatectomy (RP) according to the National Comprehensive Cancer Network (NCCN) risk stratification in patients with clinically localized PCa.Materials and Methods: This retrospective study analyzed 340 consecutive patients diagnosed with clinically localized PCa who underwent RP with preoperative mpMRI between March 2020 and December 2021. They were stratified according to the NCCN risk stratification into low (LR), favorable intermediate (FIR), unfavorable intermediate (UIR), and high risk (HR) groups to assess final pathological EPE. The accuracy of staging mpMRI was assessed in each group. Univariate and multivariate analyses evaluated the predictors of EPE in the final pathology after RP.Results: Preoperative mpMRI showed suspicious EPE in 87 patients (25.6%), whereas postoperative pathological evaluation revealed EPE in 137 patients (40.3%). The LR group showed relatively low sensitivity and positive predictive value compared with other groups. In the multivariate analysis, suspicious EPE on mpMRI was a significant predictive factor for EPE in the final pathology in the FIR, UIR, and HR groups (p=0.012, p=0.011, and p=0.001, respectively), whereas no correlation was observed in the LR group (p=0.711).Conclusions: A strong correlation was observed between suspicious EPE on mpMRI and EPE in the final pathology in the FIR, UIR, and HR groups but not in the LR group.","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116622465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.22465/juo.234600180009
J. Ku, H. Gu, Seong Hyeon Yu, E. Hwang, M. Han, J. Jung, Hunju Lee, Myung Ha Kim, C. Kwak, S. I. Kim
Purpose: There is a lack of guidelines for using angioembolization to manage renal cell carcinoma (RCC) patients with intractable symptoms. Therefore, the Korean Urologic Oncology Society (KUOS) developed a set of recommendations for angioembolization for RCC patients with intractable symptoms who are unfit for surgery.Materials and Methods: A rigorous systematic review was performed and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology was used to rate the certainty of the evidence for the patient outcomes and to develop the evidence into recommendations. The steering group, guidelines development group, systematic review team, and external review group consisted of KUOS members involved in the guideline development process.Results: The guidelines address the benefits, harms, patients’ values and preferences, costs, and resources related to angioembolization by using a single clinical question: Does angioembolization improve the quality of life for RCC patients with intractable symptoms who are unfit for surgery?Conclusions: The guideline development panel suggests angioembolization for RCC patients with intractable symptoms compared with supportive therapies, including systemic treatment (very low certainty of evidence, weak recommendation).
{"title":"Korean Urologic Oncology Society Guidelines: Does Angioembolization Improve the Quality of Life for Renal Cell Carcinoma Patients With Intractable Symptoms Who Are Unfit for Surgery?","authors":"J. Ku, H. Gu, Seong Hyeon Yu, E. Hwang, M. Han, J. Jung, Hunju Lee, Myung Ha Kim, C. Kwak, S. I. Kim","doi":"10.22465/juo.234600180009","DOIUrl":"https://doi.org/10.22465/juo.234600180009","url":null,"abstract":"Purpose: There is a lack of guidelines for using angioembolization to manage renal cell carcinoma (RCC) patients with intractable symptoms. Therefore, the Korean Urologic Oncology Society (KUOS) developed a set of recommendations for angioembolization for RCC patients with intractable symptoms who are unfit for surgery.Materials and Methods: A rigorous systematic review was performed and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology was used to rate the certainty of the evidence for the patient outcomes and to develop the evidence into recommendations. The steering group, guidelines development group, systematic review team, and external review group consisted of KUOS members involved in the guideline development process.Results: The guidelines address the benefits, harms, patients’ values and preferences, costs, and resources related to angioembolization by using a single clinical question: Does angioembolization improve the quality of life for RCC patients with intractable symptoms who are unfit for surgery?Conclusions: The guideline development panel suggests angioembolization for RCC patients with intractable symptoms compared with supportive therapies, including systemic treatment (very low certainty of evidence, weak recommendation).","PeriodicalId":125788,"journal":{"name":"Journal of Urologic Oncology","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124657673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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