As the diagnostic efficacy and safety of magnetic resonance imaging (MRI)–transrectal ultrasound (TRUS) fusion-targeted transrectal biopsy for prostate cancer (PCa) detection have already been demonstrated when compared with those of conventional systematic biopsy, we aimed to further evaluate them.
In this retrospective study, we included patients who underwent MRI–TRUS fusion-targeted transrectal biopsy combined with systematic biopsy between 2022 and 2024. The detection rates for overall and clinically significant PCa and adverse event (≥ grade 3) rates were assessed. The results were compared with those of conventional systematic biopsies using propensity score matching.
In 223 patients who underwent MRI–TRUS fusion biopsy combined with systematic biopsy (initial biopsy, 161; repeat biopsy, 62), the median prostate-specific antigen level was 8.0 ng/mL; the median prostate volume was 35 mL. The overall, clinically significant, and insignificant PCa detection rates were 67%, 60%, and 8%, respectively. After propensity score matching, detection rates were significantly higher in the MRI–TRUS fusion group than in the control group for overall PCa (66% vs. 49%, p = 0.005) and clinically significant PCa (58% vs. 41%, p = 0.005), but were not significantly different for clinically insignificant PCa (8% vs. 8%, p = 1.000). The adverse event rate (≥ grade 3) was not significantly different between the groups (3% vs. 3%, p = 1.000).
Compared with conventional biopsy, MRI–TRUS fusion-targeted transrectal biopsy combined with systematic biopsy could effectively detect clinically significant PCa without increasing detection of clinically insignificant PCa and adverse event rates.
To evaluate the incidence and clinical predictors of gastrointestinal and hepatic adverse events following oral administration of 5-aminolevulinic acid hydrochloride (5-ALA) before transurethral resection of bladder tumors (TURBT).
Safety data were analyzed from 145 patients enrolled in the prospective, single-arm, multicenter phase III SPP2C102 trial who received 5-ALA 4–8 h before TURBT. The incidence and severity of nausea, vomiting, and liver dysfunction, defined by elevations in aspartate aminotransferase, alanine aminotransferase, and/or gamma-glutamyltransferase, were assessed according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Potential risk factors were evaluated using univariable and multivariable logistic regression; results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (CIs).
Nausea/vomiting occurred in 28/145 patients (19.3%), all CTCAE grade 1–2. Female sex was independently associated (aOR 3.15, 95% CI 1.17–8.47), and diastolic blood pressure ≥ 80 mmHg showed a borderline association (aOR 2.37, 95% CI 0.99–5.78). Prophylactic antiemetics yielded a numerically lower rate (21.1% vs. 9.1%; p = 0.25). Liver-enzyme elevations similarly occurred in 28/145 patients (19.3%), all CTCAE grade 1–2. Systolic blood pressure ≥ 130 mmHg remained independently associated (aOR 4.73, 95% CI 1.62–13.78), whereas associations for hypertensive comorbidity and BMI ≥ 25 kg/m2 in univariable analyses did not persist after adjustment.
5-ALA–related nausea, vomiting, and transient liver-enzyme elevations were common but generally mild. Simple bedside variables—particularly sex and blood pressure—may guide selective antiemetic prophylaxis and closer biochemical monitoring in routine practice.
This narrative review synthesizes contemporary evidence and provides practical guidance for oligometastatic prostate cancer (OMPC) and oligometastatic bladder cancer (OMBC), focusing on image-guided patient selection and integrating metastasis-directed therapy (MDT). In OMPC, phase II randomized trials show that consolidating all imaging-visible lesions—most commonly with stereotactic body radiotherapy (SBRT)—prolongs progression-free survival, delays systemic therapy escalation, and extends both androgen deprivation therapy-free and eugonadal progression-free survival. This is achieved with low severe toxicity rates with organ-at-risk dose constraints. Elective nodal radiotherapy enhances regional control of pelvic nodal recurrence, and MDT can be layered onto modern systemic backbones in the metachronous oligometastatic, synchronous oligometastatic and oligoprogressive settings, provided that complete lesion ablation is feasible. Prostate-specific membrane antigen (PSMA) PET/CT is pivotal for staging and restaging, while whole-body diffusion-weighted MRI serves as a complementary tool for assessing disease activity, particularly in treated bone metastases. In OMBC, MDT is most appropriately considered a consolidation strategy for patients with near-complete response and few technically amenable residual lesions, or to control oligoprogression, allowing an otherwise effective systemic regimen to be maintained. While prospective and retrospective data support high local control rates, robust, disease-specific randomized evidence of survival benefit remains limited. In both diseases, successful outcomes hinge on harmonized definitions, explicit lesion enumeration, adherence to dose-volume constraints for ablative techniques, and patient-centered endpoints. Future priorities include developing biologically informed patient selection criteria, standardizing imaging and reporting protocols, and conducting randomized trials to quantify the incremental benefit of MDT beyond contemporary systemic therapy.
To evaluate the impact of age on treatment patterns and outcomes in patients with non-metastatic castration-resistant prostate cancer (nmCRPC).
We conducted a retrospective multicenter analysis of 428 patients with nmCRPC from 25 tertiary centers (2002–2022). Patients were divided into two age groups: < 80 and ≥ 80 years. The outcomes included cancer-specific survival (CSS), overall survival (OS), and progression-free survival (PFS).
Among 428 patients (median follow-up, 32.5 months), performance status (PS) 0 was more frequent in < 80 vs. ≥ 80 years (78% vs. 58%, p < 0.001). Use of first-line androgen receptor signaling inhibitors (ARSIs) was similar (58% vs. 59%, p = 0.83) among all, whereas any-line docetaxel use was less common in patients aged ≥ 80 years (33% vs. 9% for < 80 vs. ≥ 80, p < 0.001). Five-year CSS was 76.5% vs. 63.7% (p = 0.002) and five-year OS 73.8% vs. 59.9% (p = 0.006) for < 80 vs. ≥ 80 years, respectively. Time-to-treatment failure was shorter in patients aged ≥ 80 years (p = 0.04).
Maintaining PS and managing ARSI-related adverse events are essential in older patients with nmCRPC and may preserve their eligibility for chemotherapy and improve their prognosis.
To assess the impact of urinary diversion (UD) type on complications following radical cystectomy (RC) in female patients.
We retrospectively reviewed our RC database for all female RCs between 2003 and 2024. Patients were categorized by UD type: ileal conduit (IC), neobladder (NB), and continent cutaneous diversion (CCD). Postoperative complications were compared across UDs. The contemporary sub-cohort (2012–2024) was assessed to identify the determinants of genitourinary (GU) complications.
A total of 531 female patients underwent RC with UD (IC: 263 [49.5%], NB: 206 [38.8%], and CCD: 62 [11.7%]). The overall 30 (NB: 54.9%, CCD: 51.6%, IC: 61.6%) and 90 day (NB: 65.5%, CCD: 64.5%, IC: 70.3%) complication rates were comparable (p = 0.195, and 0.456, respectively). All 90 day complication subtypes—including infectious, gastrointestinal, and cardiac—were comparable, except for GU complications, which were significantly more frequent in CCD compared to IC and NB (32.3%, 13.3%, and 14.6%, respectively, p < 0.001). Assessment of the contemporary sub-cohort (n = 320 with IC: 187 [58.4%], NB: 99 [30.9%] and CCD: 34 [10.6%]) confirmed these findings (90 day GU complications rate: CCD: 41.2%, NB: 21.2%, and IC: 17.7%; p = 0.009). After adjusting for age, comorbidities, and surgical approach, CCD UD remained associated with higher odds of 90 day GU complications (ref: IC; odds ratio: 3.79, 95% CI: 1.58–9.10, p = 0.011).
UD type had minimal impact on overall 30 and 90 day postoperative complications in female RC patients. However, CCD was associated with significantly increased odds of 90 day GU complications.
Progression to castration-resistant prostate cancer is influenced by immunosuppressive cells. Whole blood RNA profiling targeting these cells offers a minimally invasive method for prognostication and treatment stratification.
Patients scheduled to undergo prostate biopsy at Kanazawa University Hospital between July 2019 and April 2023 were prospectively enrolled. Whole blood samples were collected at the time of biopsy, and time to castration-resistant prostate cancer was analyzed based on immunosuppressive cell-related gene expression patterns.
Among the 400 patients who underwent prostate biopsy, 176 prostate cancer cases and 97 non-malignant cases were analyzed. Of the prostate cancer cases, 43 (24%) had metastatic disease. In prostate cancer patients, whole blood expression of CCR2, CCL5, CCR4, and FOXP3 was significantly elevated in metastatic cases and associated with a shorter time to castration-resistant prostate cancer. Based on the number of highly expressed genes, patients were stratified into poor (3–4 genes), intermediate (1–2 genes), and favorable (0 genes) risk groups. This classification revealed distinct progression rates, with 2-year castration-resistant prostate cancer-free survival rates of 74%, 84%, and 92% for the poor, intermediate, and favorable groups, respectively. Among metastatic patients, CCR2 was the only gene that remained significantly associated with earlier progression to castration-resistant prostate cancer (p = 0.0038).
Immune-related gene expression in peripheral blood may serve as a minimally invasive prognostic biomarker for prostate cancer progression.
Enfortumab vedotin (EV) has emerged as a key agent in the evolving treatment paradigm for metastatic urothelial carcinoma (UC). Although EV-induced peripheral neuropathy (PN) occurs frequently, its risk factors and detailed clinical course remain unclear.
This multicenter study included 115 consecutive patients with metastatic UC who were treated with EV monotherapy between 2021 and 2023. The incidence, risk factors, and clinical course of PN were analyzed retrospectively.
The median age was 74 years, and 85 (74%) were male. EV was initiated at a reduced dose of < 1.25 mg/kg in 35 (30%) patients. PN occurred in 29 (25%) patients, with a cumulative incidence of 28% at 1 year following EV induction. The maximum PN grades were 1, 2, and 3 in 9 (7.8%), 17 (15%), and 3 (2.6%) patients, respectively. The median time to PN onset was 2.7 months. In multivariable analysis, higher serum albumin levels and starting EV at full-dose were significantly associated with PN development. Of the patients who experienced Grade 1 PN and whose doses were maintained, 66.6% progressed to Grade 2 or higher. Of the patients who experienced Grade 2 PN and whose doses were maintained, 82% remained at Grade 2, while 18% ultimately progressed to Grade 3.
Higher serum albumin levels were significantly associated with EV-induced PN. Appropriate dose reduction may help prevent progression from Grade 2 to Grade 3 PN. Nevertheless, further prospective studies are warranted to determine the optimal dose management strategy for long-term EV therapy.
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