Scandinavian Journal of Urology最新文献

Objective: This study aimed to evaluate the feasibility of thermal imaging for the diagnosis of acute testicular pain. Pain is usually caused by infection, inflammation or torsion of the testis or testicular appendage. Diagnosis is based on examination, laboratory tests, and Doppler ultrasound (DU), which is investigator dependent and may cause delays. Thermal imaging is a fast and noninvasive method for measuring surface temperature.

Materials and methods: Our 3-month pilot study investigated the feasibility of thermal imaging for the diagnosis of acute testicular pain. Eighteen consecutive patients were examined using a thermal camera.

Results: Two patients had testicular torsion (group 1), two had torsion of the testicular appendage (group 2), four had bacterial epididymitis (group 3), and 10 had inflammatory epididymitis (group 4). The mean ± standard deviation (SD) temperature differences between symptomatic and a reference asymptomatic testicles were -0.65 ± 0.57°C (range, -1.1 to -0.2°C), -0.15 ± 0.21°C (range, -0.3 to 0.0°C), +0.65 ± 0.25°C (range, +0.4 to +1.0°C), and +0.39 ± 0.87°C (range, -1.0 to +1.8°C) in groups 1, 2, 3, and 4, respectively.

Conclusions: Thermal imaging is a feasible, noninvasive method for evaluating acute testicular pain. It may serve as a rapid diagnostic tool, but its clinical value must be confirmed in large prospective trials.

Background: Muscle invasive bladder cancer (MIBC) is an aggressive disease with a high mortality rate. Radical cystectomy (RC) is the standard treatment for MIBC and selected non-muscle invasive bladder -cancer (NMIBC) cases. The NorCys-study (NCT04523038, NCT04537221 and NCT04523025) aims to validate biomarkers predicting RC outcomes. This report describes RC practice patterns across the Nordic countries.

Materials and methods: This prospective, multi-institutional study included bladder cancer patients undergoing RC with or without preoperative chemotherapy in all five Nordic countries from 5/2020 to 1/2025. Clinical and pathological data were collected prospectively into REDCap database and analysed using descriptive statistics, Wilcoxon rank sum and Pearson's Chi-squared tests.

Results: A total of 1,642 patients from 15 centres were enrolled. Of these, 35% (531) had clinical NMIBC (T1-Tis-Ta), and 65% (999) had cT2-4 disease. Preoperative chemotherapy was administered to 398/929 (43%) cT2-4 or node-positive patients. The most common neoadjuvant chemotherapy (NAC) regimens were gemcitabine - cisplatin (GC) (275/475 [58%]) and dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) (144/475 [30%]). Robot-assisted RC was the most common surgical approach administered in 886 of 1,472 (60%) cases, with variation between centres. Ileal conduit was the predominant diversion method in 1,375 out of 1,465 cases (94%). Median surgical time was 322 min, blood loss was 300 mL and hospital stay was 9 days. Final pathology demonstrated pT0 in 29%, ≥pT2 in 43% and lymph node metastases 203 (17%).

Conclusion: This study reports current RC practices amongst Nordic countries. Patient cohorts did not differ between countries, and although the practices were generally similar, some differences were noted in chemotherapy regimens, the use of robotic-assisted surgery and rates of early RC.

Background and aim: Magnetic resonance imaging (MRI) is crucial for prostate cancer (Pca) diagnosis, risk stratification, and treatment planning. However, large-scale observational studies require structured MRI data, which are often only obtainable from free-text reports. We aimed to extract information from narrative prostate MRI reports and to describe subsequent biopsy outcomes in a nationwide population-based cohort.

Methods: We identified 108,361 prostate MRI examinations in Prostate Cancer database Sweden with extended treatments and endpoints data (PCBase Xtend) performed in 2015-2023. A rule-based text recognition algorithm was created and used to extract Prostate Imaging Reporting and Data System (PI-RADS) score and prostate volume from free-text MRI reports. Extracted data were validated against manually extracted information in the National Prostate Cancer Register (NPCR). We examined biopsy rates and Gleason score according to PI-RADS, Prostate Specific Antigen (PSA) density, and calendar year.

Results: The proportion of reports with identifiable PI-RADS scores increased from 38% in 2015-2016 to 83% in 2022-2023, with excellent agreement with NPCR data (correlation coefficient r = 0.94). Extracted prostate volumes correlated well with those in NPCR (r = 0.88). Biopsy rates decreased for PI-RADS 3 lesions over time, particularly in men with PSA density < 0.15 ng/ml/ml, while the proportion of men with PI-RADS 5 lesions who underwent biopsy increased. Almost all prostate cancers in men with PI-RADS 3 lesions were Gleason 6 or 7 (3+4). Gleason 9-10 was almost exclusively found in PI-RADS 5 lesions.

Conclusions: Automated extraction of information from unstructured MRI reports is feasible and accurate. The observed temporal trends reflecting increasing quality and standardization of prostate MRI support its use in large-scale epidemiological research.

Objective: Chronic inflammation of the urinary bladder is associated with the bladder pain syndrome. The treatment alternatives in humans are far from satisfactory and need further attention. Well-established preclinical models have shown that pro-inflammatory cytokines contribute to the progress of the inflammatory response behind pain and hyperalgesia. Previously presented results indicate that treatment with CernitinTM pollen extracts active pharmaceutical ingredients (APIs) (Cernitin GBX and Cernitin T60) significantly alleviated pain in cyclophosphamide-induced urinary bladder inflammation in a rodent model through downregulation of PGD2 and cyclooxygenase-2 (COX-2) mediators when compared to the vehicle alone. The objective was to extend the original study by exploring the correlation between the two APIs and cytokines expression and to identify a possible biomarker pattern.

Material and method: The Olink® Target 48 Mouse Cytokine assay was conducted on the homogenised tissue extracts of the bladder wall with induced inflammation from a previous study to identify the potential impacts on protein biomarkers.

Results: The test revealed that treatment with the APIs significantly downregulated the cytokines interleukin (IL)-1α, IL-2, IL-4, IL-6, and with trend to significance the biomarkers IL-12 α, β, CCL4 and fibroblast growth factor 21 when administered in combination (GBX+T60) or each component alone, compared to vehicle controls.

Conclusion: This study identified seven cytokines that were significantly or markedly reduced. The results suggest that CernitinTM APIs impact a series of key pro-inflammatory biomarkers demonstrating an ability to restrain inflammation. Therefore, they warrant further investigation as potential therapeutic candidates.

Purpose: In randomised clinical trials, doublet and triplet therapy improved survival compared to standard androgen deprivation therapy (ADT) in men with de novo metastatic castration-sensitive prostate cancer (mCSPC). Guidelines recommend doublet therapy since 2020 and triplet therapy since 2022. The aim of this study was to assess the uptake of upfront doublet and triplet therapy at a population level and assess trends in survival for all men with mCSPC.

Methods: We included men registered with de novo mCSPC in 2016-2024 in the National Prostate Cancer Register of Sweden. We estimated the annual proportion of men with de novo mCSPC who upfront received doublet therapy (ADT plus androgen receptor pathway inhibitor [ARPI] or docetaxel) or triplet therapy (ADT plus docetaxel and ARPI). Kaplan-Meier curves were used to estimate 3-year overall survival.

Results: In 9294 men diagnosed with de novo mCSPC, the use of upfront doublet therapy increased from 19% in 2016 to 66% in 2024, and the use of triplet therapy rose from 4% in 2021 to 17% in 2024. Uptake was highest among men below age 65 years, of whom 46% received doublet and 48% received triplet therapy in 2024. Three-year survival increased from 51% (95% CI: 49-52%) in 2016-2018 to 61% (95% CI: 58-64%) in 2022-2024. Among men below age 65, survival increased from 69% (95% CI: 65-73) in 2019-2021 to 77% (95% CI: 71-84) in 2022-2024.

Conclusions: The uptake of doublet and triplet therapy increased substantially during the study period, in particular among men below age 65. In parallel, 3-year overall survival increased in all men diagnosed with de novo mCSPC. These data provide support for the benefit of upfront doublet or triplet therapy in clinical practice.

Objective: Prostate biopsy is associated with a risk of significant infectious complications including sepsis. We investigated the risk of infections after transrectal (TR) biopsy compared to transperineal (TP) biopsy.

Materials and methods: Men who had undergone prostate biopsy and diagnosed with prostate cancer were identified in the National Prostate Cancer Register (NPCR) of Sweden. Linkage with Swedish health care registers provided information on hospitalization, antibiotic prescriptions and comorbidities. Rate ratios for hospitalization, for infections, after TR and TP biopsies over day 1-7, 1-14, and 1-30 were estimated with Poisson regression. Filled prescriptions for urinary tract related antibiotics were also assessed.

Results: Thirty-one thousand two hundred twenty-two men underwent biopsy between 1 January 2020 and 31 December 2023. 87% underwent TR and 13% TP biopsy. Hospitalization occurred in 0.6% of men (n = 24) after TP biopsy and 2.0% (n = 548) after TR biopsy. Rate ratios for hospitalization in the TR group compared to TP were 8.0 (95% confidence interval [CI]: 4.0-16.2) for day 1-7, 6.2 (3.2-11.9) for day 1-14, and 4.1 (2.4-6.8) for day 1-30. Filled antibiotic prescriptions were found for 4.5% of men (n = 187) after TP biopsy and 6.9% (n = 1,883) after TR biopsy. For antibiotic prescriptions, the rate ratios were 2.3 (1.8-2.9) for day 1-7 as well as day 1-14, and 1.6 (1.3-1.9) for day 1-30.

Conclusions: A transrectal prostate biopsy was associated with a significantly higher risk of post-biopsy infectious complications compared to transperineal biopsy. These findings support the use of transperineal biopsy.

Objective: To compare adjustable continence balloons (ProACT) implanted above the pelvic floor with or without subsequent placement of a third balloon (AP) with a modified technique placing balloons below the pelvic floor (BP).

Materials and methods: We retrospectively compared 38 men who underwent the BP procedure and 38 men who received the AP technique. Primary outcome was continence (≤1 pad/day or <8 ml/24 h leakage). Secondary outcomes included operative time, complications, number of balloon filling visits, and satisfaction.

Results: Median age was 75.5 years (BP) and 70.5 years (AP) (p < 0.0001). Groups were comparable in preoperative incontinence severity. Median surgical time was 15 min (BP) versus 20 min (AP) (p = 0.034). Early retention occurred in 18.4% (BP) versus 0% (AP) (p = 0.012). A third balloon was inserted in 39.4% of AP patients, and median number of fillings (6 vs. 10, p = 0.0006) was lower in BP group. Late complications consisting of migration, erosion, and balloon puncture were similar (23.7% BP vs. 36.8% AP, p = 0.32). Continence was achieved in 52.6% (BP) and 57.9% (AP) (p = 0.64), and satisfaction was reported by 71.1% (BP) and 57.9% (AP) (p = 0.34). On multivariate analyses, surgical method did not predict outcomes, and Cox regression shoved that BP was associated with a non-significant hazard of revision (HR: 1.60; 95% confidence interval [CI]: 0.53-4.85; p = 0.40).

Conclusions: ProACT placement below the pelvic floor yielded similar continence but reduced operative time and postoperative visits, at the cost of more early retention.

Objective: This study aimed to compare test sensitivity for detecting aggressive prostate cancer and test specificity (measured by reduction in prostate biopsies) between algorithm-triage and standard systematic biopsy in elderly men with suspected prostate cancer.

Methods: This randomised controlled trial enrolled men ≥ 70 years old suspected of prostate cancer and randomised them 1:1 to algorithm-triage or standard systematic biopsies. The algorithm arm used a 10-gene mRNA panel from urine and plasma samples, integrated with clinical characteristics and PSA measurements to predict prostate cancer with International Society of Urological Pathology grade group ≥ 2. Patient-reported outcomes measures were collected using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) scores or subdomains throughout a 24-month follow-up.

Clinicaltrials: gov: NCT04079699.

Results: A total of 202 men were included between October 2019 and September 2021. The study was terminated early due to algorithm underperformance. The algorithm-triage arm detected fewer indolent cancers (7.9% vs. 19%, absolute difference -10.9 percentage points, 95% confidence interval [CI]: -21.0 to -1.0 pp, P = 0.039) but also fewer clinically significant cancers (26% vs. 40%, absolute difference -13.9 percentage points, 95% CI: -27.6 to -0.1 pp, P = 0.051) compared to systematic biopsy. Patient-reported outcomes showed no significant between-group differences in FACT-P scores or subdomains throughout 24-month follow-up (differences 0.1-2.2 points, all P > 0.05), indicating comparable quality of life.

Conclusion: The biomarker-based algorithm-triage reduced biopsy numbers but also detected fewer -clinically significant prostate cancers. Quality of life was comparable between approaches.

Introduction and objectives: Definitions of prostate specific antigen progression for men with prostate cancer on androgen deprivation therapy (ADT) are mainly derived from randomised trials, and their applicability to the clinical practice remains uncertain. This study aimed to assess how different PSA-based definitions of progressions while on ADT affect estimates of progression, treatment initiation, and outcomes in men with prostate cancer.

Methods: Using data from the Prostate Cancer database of Sweden with extended treatments and endpoints data (PCBase Xtend), we identified 3718 men who initiated ADT between 2009 and 2022 and who had longitudinal PSA and treatment data. PSA progression was defined according to four modified guideline-based definitions ranging from the European Association of Urology (EAU) that has the most stringent criteria for progression to our previously used and less stringent definition (PCBase). We analysed cumulative incidence of PSA progression, treatment for castration resistant prostate cancer before and after PSA progression, and prostate cancer-specific mortality, accounting for competing risks.

Results: ADT was prescribed as the primary treatment in 52% of included men. The number of men with PSA progression ranged by definition from 1047 men (28%, EAU) to 2378 men (64%, PCBase) at 10 years after initiation of ADT. Earlier progression was observed with less stringent criteria, with a difference in median time to progression of 3 months (PCBase vs EAU). Despite variation in incidence proportion of PSA progression, the proportion of men treated within 5 years after progression was similar (45-52%), as was prostate cancer-specific mortality (26-27%) across definitions.

Conclusion: While definitions of PSA progression significantly impacted estimated incidence proportion of disease progression, they had limited influence on treatment initiation and long-term mortality. These findings suggest that in the clinical practice, decisions are guided by factors other than formal progression criteria. PSA-based definitions can be useful in observational studies if supported by sensitivity analyses.