Journal of Urology最新文献

Purpose: Ta low-grade bladder tumors, accounting for 45% of new bladder cancer cases, have considerable risk of recurrence but low risk of progression. Traditionally, treatment is burdensome and costly. Office-based laser coagulation of Ta low-grade bladder tumors is efficient, tolerable, and safe; however, long-term outcomes need to be determined. The primary objective of this study was to determine whether in-office laser coagulation of recurrent Ta low-grade bladder tumor is noninferior to standard transurethral resection of bladder tumor (TUR-BT) regarding 12-month recurrence-free survival (RFS).

Materials and methods: Prospective, randomized, noninferiority clinical trial, performed in a hospital setting in Denmark between 2016 and 2022. Three hundred consecutive patients with recurrent Ta low-grade bladder tumor participated. Laser (photograph) coagulation of the bladder tumor (PC-BT) was performed with a 980 nm laser under local anesthesia in an office setting and compared with gold standard TUR-BT under general anesthesia. Primary outcome, 12-month RFS, was analyzed with noninferiority criterion of 15% absolute difference. Secondary outcomes included long-term RFS and stage progression.

Results: RFS at 12 months was 43.5% after PC-BT and 43.0% after TUR-BT; difference of -0.5% compared with PC-BT (one-sided 95% CI upper bound 12%), meeting noninferiority requirement. During extended follow-up (median 47.9 months), RFS was not significantly different between groups (P = .25) and only one case of stage progression was observed in each group.

Conclusions: Office-based laser photograph coagulation of bladder tumor is noninferior to TUR-BT regarding 12-month RFS and is a safe, efficient treatment for recurrent Ta low-grade bladder tumors.

Purpose: Subjectivity of PCa grading affects biomarker investigations, assessments of imaging, and treatment decisions, especially for active surveillance. We conducted the first telepathology concordance study of PCa needle biopsy grading using contemporary International Society of Urologic Pathology guidelines.

Methods: Whole slide images (n = 120) of PCa biopsy cases across grade groups (GGs) were examined by 11 urologic pathologists. Forty cases were blindly regraded, oversampling cases with lower agreement on first review. Pathologists provided GG, percentage and type of pattern Gleason 4, and tumor length. Consensus for a case was defined as GG agreement by ≥ 7 pathologists. GG agreement among and within pathologists was measured using model-based weighted Kappa statistics (κ_w).

Results: Consensus was achieved on 86/120 (72%) cases. Of 34 cases not achieving consensus, most were GG2 vs GG1 (41%) or GG2 vs GG3 (38%). The inter-rater κ_w was 0.34 (95% CI 0.28, 0.39) indicating fair agreement. Forty regraded cases had an intrarater κ_w of 0.49 (95% CI 0.46, 0.53; moderate agreement). Sixty-four percent of the repeated grades agreed. Of the repeated ratings that did not agree, 39% involved GG1 vs GG2. Of the GG1 vs GG2 paired repeated ratings, 77% reported 1-10% pattern 4, and indicated common observation was "poorly formed glands."

Discussion: Inter-rater and intrarater variability in GG is significant, particularly discerning GG1 from GG2 with ≤ 10% grade 4. These observations have profound implications for treatment decisions (surveillance vs definitive therapy) and studies of new biomarkers and imaging of prostate cancer.