Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Estimating the prevalence of germline mutations in DNA mismatch repair genes among patients with upper tract urothelial carcinoma: a systematic review and meta-analysis","authors":"Joseph Moryousef MD ,&nbsp;Braden Millan MD ,&nbsp;Piotr Zareba MD","doi":"10.1016/j.urolonc.2026.110999","DOIUrl":"10.1016/j.urolonc.2026.110999","url":null,"abstract":"<div><h3>Background</h3><div>Lynch syndrome is a hereditary cancer predisposition syndrome caused by germline mutations in the DNA mismatch repair (MMR) genes <em>MSH2, MSH6, MLH1</em> and <em>PMS2</em>. The objective of this systematic review was to estimate the prevalence of germline mutations in MMR genes among patients with upper tract urothelial carcinoma (UTUC).</div></div><div><h3>Methods</h3><div>Literature searches were performed using MEDLINE, EMBASE and Web of Science Core Collection. Studies of interest were selected and data were abstracted independently by two reviewers. Prevalence estimates were transformed using the Freeman-Tukey method and pooled using a random effects model. Heterogeneity and publication bias were assessed quantitatively using the <em>I²</em> statistic and Egger’s test, respectively.</div></div><div><h3>Results</h3><div>Fourteen studies, which included 2,378 patients, were found. Eight of these studies were performed either in China or Japan, with the remainder coming from the United States and Europe. The pooled prevalence of germline mutations in MMR genes was 3.2% (95% confidence interval [95% CI] 2.1%, 4.4%, <em>I²</em>=54%). The prevalence was lower among studies from East Asia than those from North America and Europe (2.4% vs. 4.7%, <em>P</em>=0.087). <em>MSH2</em> was the most commonly mutated gene and 86% of the patients who tested positive were less than 60 years of age or had a prior cancer diagnosis.</div></div><div><h3>Conclusions</h3><div>LS prevalence among patients with UTUC is similar to that among patients with colorectal and endometrial cancers, which provides a strong rationale for LS testing in this population. Further research is necessary to determine the optimal diagnostic strategy.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110999"},"PeriodicalIF":2.3,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not all PI-RADS 3 lesions are the same: Higher rate of clinically significant prostate cancer among Black men on targeted biopsy in a diverse cohort","authors":"David G Hanelin ,&nbsp;Priya Dave M.D. ,&nbsp;Andrewe Baca M.D. ,&nbsp;Morgan Joseph ,&nbsp;Rutul Patel M.D. ,&nbsp;Alexander Sankin M.D. ,&nbsp;Ahmed Aboumohamed M.D. ,&nbsp;Stephen Reese M.D. ,&nbsp;Ilir Agalliu M.D., Sc.D. ,&nbsp;Kara Watts M.D.","doi":"10.1016/j.urolonc.2026.110995","DOIUrl":"10.1016/j.urolonc.2026.110995","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Radiogenomic studies suggest phenotypic differences in prostate cancer (PCa) appearance on MRI across racial groups. Counseling for PI-RADS 3 lesions is particularly challenging due to low positive predictive value and limited multi-ethnic data. We evaluated the association between PI-RADS score and PCa detection on MRI-targeted biopsy across a diverse patient population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of patients who underwent MRI-targeted fusion biopsy for PI-RADS 3 to 5 lesions between 2016 and 2024. Demographic and pathologic data were collected. Mixed-effects logistic regression assessed associations between race and PCa and csPCa, adjusting for clinical/radiographic features, stratified by PI-RADS score.</div></div><div><h3>Results</h3><div>646 patients with 1,146 lesions were analyzed (mean age 63.2 ± 7.6). The cohort was 48.1% Non-Hispanic Black (NHB), 32.5% Hispanic, and 19.3% Non-Hispanic White (NHW). PCa detection rates were 45.0% in NHB, 36.0% in Hispanic, and 35.8% in NHW. NHB had increased odds of overall and csPCa detection compared to NHW (Odds Ratio [OR] = 2.00; 95% Confidence Interval [95% CI] 0.96–4.18; <em>P</em> = 0.06, OR = 1.78, 95% CI 0.85–3.71; <em>P</em> = 0.12). On biopsy of PI-RADS 3 lesions, NHB men demonstrated nearly fivefold higher odds of csPCa detection compared to NHW and Hispanic cohorts (OR = 4.86; 95% CI 1.26–18.77; <em>P</em> = 0.02). No significant differences were observed between Hispanic and NHW men.</div></div><div><h3>Conclusions</h3><div>NHB had significantly higher odds of csPCa detection on targeted biopsy of PI-RADS 3 lesions. These findings support emerging data that phenotypic appearance of prostate cancer on MRI differs by race and may be relevant for risk stratification and management counseling of PI-RADS 3 lesions.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110995"},"PeriodicalIF":2.3,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient awareness and perspectives regarding the value of focal therapy for localized prostate cancer: A cross-sectional study","authors":"Abdul-Qahar K. Yasinzai M.D. ,&nbsp;Jordan Smith M.D. ,&nbsp;Amica Lertkitcharoenpo B.S. ,&nbsp;Rafael A. Bourricaudy B.S. ,&nbsp;Jane J. Chang M.S. ,&nbsp;Thomas F. Stringer M.D., F.A.C.S. ,&nbsp;John Michael DiBianco M.D. ,&nbsp;Jason P. Joseph M.D. ,&nbsp;Padraic O’Malley M.D., F.R.C.S.C. ,&nbsp;Paul L. Crispen M.D. ,&nbsp;Li-Ming Su M.D., F.R.C.S. ,&nbsp;Tarik Benidir M.D., F.R.C.S.C.","doi":"10.1016/j.urolonc.2026.110993","DOIUrl":"10.1016/j.urolonc.2026.110993","url":null,"abstract":"<div><h3>Background</h3><div>With the expanding therapeutic options for localized prostate cancer (PCa), little is known regarding patient values and perspectives that influence the selection process for focal therapy (FT) vs. conventional treatments. This study explores the socioeconomic and demographic factors that influence patients' decisions for FT.</div></div><div><h3>Methods</h3><div>This was a single-center cross-sectional study using a patient-centered survey of men with concerns about or a diagnosis of localized prostate cancer who were potential candidates for focal therapy. Information on patient demographics and clinical status was collected along with hypothetical scenarios to study the preferences of patients. Descriptives and univariate tests of associations were utilized for analysis.</div></div><div><h3>Results</h3><div>In total, 158 patients were enrolled; only 41.1% of patients had prior knowledge of FT. Among those with a diagnosis of PCa and endorsing prior FT knowledge, 44.3% did not understand its efficacy, while 27.9% did not know if FT has any potential side effects. Education and income significantly influenced FT knowledge. Specifically, 52.4% of patients with advanced education were familiar with FT compared to 20% of those with only a high school education (<em>P</em> &lt; 0.01). Patients with income of &gt;$75,000 were more likely to be aware of FT (60.7%, <em>P</em> = 0.010). Interestingly, neither disease stability nor treatment status influenced therapy preferences. Sexually active patients were more likely to be aware of FT as an option.</div></div><div><h3>Conclusions</h3><div>A considerable proportion of PCa patients, specifically those in lower socioeconomic groups, remain unaware of FT’s existence and its potential role in well-selected PCa management. Educated and higher-income patients had comparatively better knowledge about FT and also leaned towards functional outcomes. As FT demand continues to expand, addressing knowledge gaps is crucial to ensure informed and equitable healthcare delivery.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110993"},"PeriodicalIF":2.3,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incremental dose-response effect of age on mortality in non-seminoma testis cancer patients","authors":"Reha-Baris Incesu M.D. ,&nbsp;Mattia Luca Piccinelli M.D. ,&nbsp;Simone Morra M.D. ,&nbsp;Lukas Scheipner M.D. ,&nbsp;Stefano Tappero M.D. ,&nbsp;Francesco Barletta M.D. ,&nbsp;Cristina Cano Garcia M.D. ,&nbsp;Zhe Tian M.Sc. ,&nbsp;Fred Saad M.D. ,&nbsp;Shahrokh F. Shariat M.D. ,&nbsp;Felix K.H. Chun M.D. ,&nbsp;Alberto Briganti M.D., Ph.D. ,&nbsp;Carlo Terrone M.D. ,&nbsp;Sascha Ahyai M.D. ,&nbsp;Nicola Longo M.D. ,&nbsp;Ottavio de Cobelli M.D. ,&nbsp;Derya Tilki M.D. ,&nbsp;Markus Graefen M.D. ,&nbsp;Pierre I. Karakiewicz M.D.","doi":"10.1016/j.urolonc.2026.110991","DOIUrl":"10.1016/j.urolonc.2026.110991","url":null,"abstract":"<div><h3>Background</h3><div>Age ≥ 40 predisposes to higher testis cancer-specific mortality (CSM) in non-seminoma. However, it is unknown, whether an incremental dose-response effect applies to subgroups of testis cancer patients (tertiles aged ≥ 40). We tested this hypothesis in contemporary non-seminoma patients.</div></div><div><h3>Methods</h3><div>The Surveillance, Epidemiology, and End Results (SEER) database (2004−2018) was used. Kaplan-Meier plots and multivariable Cox regression models tested the effect of age on CSM after stratification for stage (I vs. II vs. III).</div></div><div><h3>Results</h3><div>Of 13,679 non-seminoma patients, 11,034 (81%) were aged &lt; 40 vs. 2,645 (19%) were aged ≥ 40. Of patients aged ≥ 40, 943 were aged 40 to 44 (young age tertile) vs. 855 were aged 45 to 52 (intermediate age tertile) vs. 847 were aged ≥ 53 (old age tertile). In overall multivariable analyses relative to patients aged &lt; 40, young age tertile (Hazard ratio [HR] 1.4, <em>P</em> &lt; 0.01), intermediate age tertile (HR 1.9, <em>P</em> &lt; 0.001) and old age tertile (HR 3.6, <em>P</em> &lt; 0.001) were associated with higher CSM. In stage-specific multivariable analyses relative to patients aged &lt; 40, old age tertile predicted higher CSM in stage I (HR 4.7, <em>P</em> &lt; 0.001), stage II (HR 9.9, <em>P</em> &lt; 0.001) and stage III (HR 3.0, <em>P</em> &lt; 0.001). In stage III, intermediate age tertile (HR 1.9, <em>P</em> &lt; 0.001) and young age tertile (HR 1.5, <em>P</em> = 0.007) also predicted higher CSM.</div></div><div><h3>Conclusions</h3><div>We identified a dose-response effect of increasing age in non-seminoma patients aged ≥ 40, in the overall analysis as well as in stage-specific analyses.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110991"},"PeriodicalIF":2.3,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbial profiling of urothelial carcinoma and benign bladder tissue from formalin-fixed specimens","authors":"Matt Pearson MD ,&nbsp;Phillip A. Engen MS ,&nbsp;Stefan J. Green PhD ,&nbsp;Jake Emerson MD ,&nbsp;Ankur Naqib PhD ,&nbsp;Paolo Gattuso MD ,&nbsp;Ali Keshavarzian MD ,&nbsp;Christopher Coogan MD","doi":"10.1016/j.urolonc.2026.110997","DOIUrl":"10.1016/j.urolonc.2026.110997","url":null,"abstract":"<div><h3>Purpose</h3><div>Host-associated microbiota can influence host immunity and tumor responses. Emerging evidence suggests the bladder microbiome contributes to urothelial cell carcinoma (UCC), though most data come from urine samples. Urinary microbiomes are different in UCC compared to inflamed bladder, though their impact on host immune responses is understudied. Similarly, the effect of <em>Bacillus</em> Calmette–Guérin (BCG) treatment on bladder microbiome remains unexplored.</div></div><div><h3>Materials and Methods</h3><div>Formalin-fixed paraffin-embedded (FFPE) transurethral resection of bladder tumor (TURBT) specimens from UCC tumor stages (T1 = 42), (T2 = 5), and 16 benign pathologies were examined. Six patients who underwent BCG vaccine with post-treatment TURBT specimens were examined. Microbial communities were characterized using RNA extraction, reverse transcription, and 16S rRNA amplicon sequencing.</div></div><div><h3>Results</h3><div>UCC patients exhibited greater microbial diversity and distinct bladder microbiome compositions compared to those with benign pathology. Several genera in the bladder including <em>Streptococcus, Staphylococcus, Actinomyces</em>, and <em>Cutibacterium</em> were more abundant in the benign group. Conversely, T1-UCC patients showed higher relative abundances of putative proinflammatory genera including <em>Escherichia-Shigella</em> and unclassified Yersiniaceae, plus commonly reported skin-associated dysbiotic genera <em>Enhydrobacter</em> and <em>Micrococcus</em>. Five of 6 BCG-treated patients showed marked reduction in microbial diversity along with significant alteration in their microbiome composition, including decreased relative abundance of bacteria from genera <em>Streptococcus</em> and <em>Rothia</em>.</div></div><div><h3>Conclusions</h3><div>This proof-of-concept study suggests that: (1) microbiome sequencing from FFPE TURBT specimens can be used for microbiota assessment and can effectively distinguish UCC from benign pathology. (2) bladder microbiomes are heavily depleted following BCG treatment, indicating therapy-induced microbiome alterations.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110997"},"PeriodicalIF":2.3,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial comment on \"Comparison of 4 local anesthetic techniques for open radical cystectomy: A prospective, randomized controlled trial\".","authors":"Alireza Ghoreifi, Hooman Djaladat","doi":"10.1016/j.urolonc.2026.111001","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.111001","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":"111001"},"PeriodicalIF":2.3,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting patient priorities care for older adults with non-muscle-invasive bladder cancer: A qualitative inquiry","authors":"Tullika Garg ,&nbsp;Steven Negron-Candelario ,&nbsp;Halle Miller ,&nbsp;Seyma Demirsoy ,&nbsp;Kirstin West ,&nbsp;William Calo ,&nbsp;Mary Tinetti ,&nbsp;Lauren J. Van Scoy","doi":"10.1016/j.urolonc.2026.110996","DOIUrl":"10.1016/j.urolonc.2026.110996","url":null,"abstract":"<div><h3>Introduction</h3><div>Shared decision-making involves understanding a person’s goals and healthcare preferences, especially for older adults with cancer. When making treatment decisions, older adults with non-muscle-invasive bladder cancer (NMIBC) face tradeoffs due to aging and multimorbidity. Our objective was to obtain initial feedback from older adults with NMIBC and their urologists to begin adapting an existing written goal-elicitation tool, Patient Priorities Care (PPC), for shared decision-making in NMIBC.</div></div><div><h3>Methods</h3><div>We recruited 5 dyads of older adults with NMIBC (age ≥65) paired with their urologists to use PPC and collected demographics. Patients also completed a frailty assessment. Qualitative interviews with participants were conducted to assess modifications needed (<em>n</em> = 10). We calculated descriptive statistics of quantitative data and used Braun and Clarke’s six-phase framework and Interpretative Phenomenological Analysis to analyze interview transcripts.</div></div><div><h3>Results</h3><div>Mean patient age was 76.4 years, and all were males and frail. Urologists had been in practice for an average of 14.8 years. Four themes emerged from the interviews: 1) PPC should be administered periprocedurally and at multiple time points, 2) PPC was appropriate but modifications were needed to the format and to make it specific to NMIBC, 3) PPC helped urologists learn about their patients, and 4) age, multimorbidity, and urinary symptoms contributed to NMIBC treatment decisions.</div></div><div><h3>Conclusions</h3><div>In this pilot qualitative study, participants found PPC easy to use with appropriate content, but it required modifications for format and specificity for NMIBC. Next steps include focus groups to further adapt PPC followed by feasibility testing in the clinic.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110996"},"PeriodicalIF":2.3,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous invasion in upper tract urothelial carcinoma: Diagnostic features and oncologic outcomes","authors":"Stephan Brönimann MD ,&nbsp;Zahra Moghimi MD ,&nbsp;Philipp Korn MD ,&nbsp;Ezra Baraban MD ,&nbsp;Farzad Sedaghat MD ,&nbsp;Nirmish Singla MD, MSCS","doi":"10.1016/j.urolonc.2026.110998","DOIUrl":"10.1016/j.urolonc.2026.110998","url":null,"abstract":"<div><h3>Objectives</h3><div>To characterize clinical, radiological and histopathological features of upper tract urothelial carcinoma (UTUC) with venous tumor thrombus (VTT) and assess associated oncological outcomes in patients who underwent radical nephroureterectomy (RNU).</div></div><div><h3>Material and methods</h3><div>We retrospectively identified consecutive patients with UTUC with VTT who underwent radical nephroureterectomy (RNU) at our institution. Cross-sectional imaging was reviewed by a dedicated genitourinary radiologist, and pathology was reviewed by a dedicated genitourinary pathologist. Clinical characteristics, radiographic features, pathologic features, and oncologic outcomes were analyzed.</div></div><div><h3>Results</h3><div>Eight patients (median age: 74 years, range: 56–91) with UTUC and macroscopic VTT were identified. Imaging consistently revealed collecting system filling defects, irregular mural thickening, and an infiltrative, noncircumscribed growth pattern. Venous involvement was confined to the renal vein in 63% and extended into the inferior vena cava in 37%. Seventy-five percent of patients had pT4 disease, and 63% had pathologic nodal involvement (pN+). Sarcomatoid differentiation was present in 88% of tumors and was disproportionately enriched within the thrombus component, while absent in nodal metastases. One patient experienced a major complication (Clavien–Dindo ≥ III) from surgery. Over a median follow-up of 13.3 months (IQR: 7.7–41.4), 71% of patients developed metastatic disease, and overall mortality was 62.5%. Two patients received adjuvant chemotherapy following surgery. Notably, one achieved a complete response to pembrolizumab, confirmed radiologically and by circulating tumor DNA (ctDNA) clearance.</div></div><div><h3>Conclusions</h3><div>UTUC with VTT represents a rare but distinctly aggressive phenotype characterized by advanced local stage, frequent nodal involvement, and a striking prevalence of sarcomatoid differentiation. The consistent enrichment of sarcomatoid elements within thrombi suggests a unique biologic behavior potentially driven by epithelial-mesenchymal transition that may underlie vascular invasion and influence treatment response. Recognizing key imaging features may facilitate accurate diagnosis, avoid misclassification as RCC, and prompt timely multimodal treatment.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110998"},"PeriodicalIF":2.3,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin use and outcomes in advanced prostate cancer:Secondary analysis of the SPARTAN trial.","authors":"Ahmad Mousa, Julian Chavarriaga, Katherine Lajkosz, Linda Z Penn, Najia Khurram, Robert J Hamilton","doi":"10.1016/j.urolonc.2026.110992","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.110992","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the impact of statin use on survival outcomes in the phase III SPARTAN trial of apalutamide for nonmetastatic castration-resistant prostate cancer.</p><p><strong>Subjects and methods: </strong>We analyzed data from all 1,207 SPARTAN participants, identifying baseline statin users and matching them 1:1 to nonusers using propensity scores. The primary endpoint was metastasis-free survival (MFS), compared between groups using Kaplan-Meier analysis. A multivariable Cox proportional hazards model, adjusted for key covariates, was applied to the matched cohort to assess associations between statin use and survival outcomes.</p><p><strong>Results: </strong>Of the 1,207 SPARTAN participants, 463 (38%) were baseline statin users; 456 users were propensity matched to 456 nonusers with balanced characteristics. Statin and nonstatin users were similarly distributed across treatment arms. While statin use was not associated with differences in metastasis-free survival (MFS) overall (P = 0.64), we observed a significant interaction by treatment arm (P = 0.018), with statin use linked to worse MFS in the placebo group (Hazard Ratio [HR] 1.40, 95% Confidence Interval [95% CI] 1.04-1.88). Statin use was also not associated with secondary endpoints overall, but again showed interaction for anticancer therapy-free survival, with harm in the placebo group (HR 1.32) and benefit in the apalutamide group (HR 0.79).</p><p><strong>Conclusion: </strong>In this secondary analysis of the SPARTAN trial, statin use was not associated with improved survival outcomes overall. However, a significant interaction was observed, with statin use linked to worse metastasis-free survival in the placebo arm. These findings suggest a hypothesized interplay between statins and androgen receptor inhibition that warrants further prospective investigation.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":"110992"},"PeriodicalIF":2.3,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive value of lesion density in enhancing multiparametric MRI for detecting clinically significant prostate cancer","authors":"Ali Khatib M.D., M.Sc. ,&nbsp;Zizo Al-Daqqaq M.D. ,&nbsp;Anna J. Black M.D. ,&nbsp;Silvia Chang M.D. ,&nbsp;Martin E Gleave M.D. ,&nbsp;Miles P. Mannas M.D., M.Sc.","doi":"10.1016/j.urolonc.2025.12.017","DOIUrl":"10.1016/j.urolonc.2025.12.017","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to evaluate the predictive value of lesion density on mpMRI for detecting clinically significant prostate cancer (csPCa) in men undergoing targeted prostate biopsy.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients who underwent MRI-targeted transperineal or transrectal biopsy between 2019 and 2023. Lesion density was calculated as longest lesion diameter divided by prostate volume, with weighted averages used for multiple lesions. Multivariable logistic regression and receiver operating characteristic (ROC) analysis assessed predictors of csPCa. Threshold analysis evaluated trade-offs between missed csPCa and avoided biopsies.</div></div><div><h3>Results</h3><div>csPCa was diagnosed in 241/460 patients (52.4%). Median lesion density was higher in csPCa vs. non-csPCa cases (0.34 mm/cc, IQR 0.22–0.52 vs. 0.22 mm/cc, IQR 0.14–0.33; <em>P</em> &lt; 0.001). Lesion density was independently predictive in models with (OR 6.2, 95% CI 1.4–27.9) and without PI-RADS (OR 13.7, 95% CI 3.2–59.0). It achieved the highest AUC (0.71) compared with PSA density (0.69) and age (0.63). At a lesion density threshold of 0.15 mm/cc, 29.2% of biopsies would have been avoided with &lt;10% missed csPCa.</div></div><div><h3>Conclusion</h3><div>Lesion density was an independent predictor of csPCa on targeted biopsy. It may complement PI-RADS and PSA density and provide a pragmatic threshold-based tool to guide biopsy decision-making.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 4","pages":"Article 110981"},"PeriodicalIF":2.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}