Pub Date : 2025-12-27DOI: 10.1016/j.urolonc.2025.12.008
{"title":"Featured SUO fellow: Jiping Zeng, MD","authors":"","doi":"10.1016/j.urolonc.2025.12.008","DOIUrl":"10.1016/j.urolonc.2025.12.008","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Page 109"},"PeriodicalIF":2.3,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850752","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}
Pub Date : 2025-12-20DOI: 10.1016/j.urolonc.2025.11.013
Xiaoyi Zhang, Na Xiao, Hao Liang, Peixin Li, Yaozhong Zhang, Shijie Zhang, Bin Zhou, Shengwen Yao, Zizhuo Yang, Jun Chen
Prostate cancer remains a major global burden; diagnostic pathways rely on prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and histopathology but face false positives, interobserver variability, and risk of overtreatment. We conducted a narrative review of peer-reviewed human studies (2015-February 2025; PubMed, Web of Science, Google Scholar) on artificial intelligence (AI) across imaging and digital pathology. Evidence shows that assistive AI can match or exceed expert performance while improving workflow. In a large international paired confirmatory study (PI-CAI), an MRI-based AI system achieved an area under the receiver operating characteristic curve (AUROC) of 0.91 versus 0.86 for 62 radiologists, detected 6.8% more Grade Group (GG) ≥2 cancers at matched specificity, and yielded ∼50% fewer false positives and 20% fewer indolent (GG1) detections at matched sensitivity. Risk tools configured for high-sensitivity rule-out (90%-95%) report high negative predictive value (NPV) 97.5% to 98.0% and enable meaningful biopsy avoidance. In digital pathology, independent assessments of Paige Prostate report 97.7% sensitivity and 99.3% specificity on core biopsies, while real-world deployments reduce immunohistochemistry requests, second-opinion rates, and reporting time. Collectively, these data support deploying AI as a second-reader/triage with standardized acquisition and quality assurance, local calibration, and drift monitoring. Priority evidence needs include multicenter prospective studies and pragmatic real-world evidence (RWE) reporting patient outcomes and cost-effectiveness, with continued attention to fairness, privacy, and regulatory compliance.
前列腺癌仍然是一个主要的全球负担；诊断途径依赖于前列腺特异性抗原（PSA）、多参数磁共振成像（mpMRI）和组织病理学，但存在假阳性、观察者之间的差异和过度治疗的风险。我们对同行评审的人类研究（2015- 2025年2月；PubMed, Web of Science， b谷歌Scholar）进行了一项关于人工智能（AI）在成像和数字病理学方面的叙述性回顾。有证据表明，辅助人工智能可以在改善工作流程的同时达到或超过专家的表现。在一项大型国际配对验证性研究（PI-CAI）中，基于mri的AI系统在62名放射科医生中获得的受试者工作特征曲线下面积（AUROC）为0.91，而不是0.86，在匹配的特异性下检测到的分级组(GG)≥2级癌症多6.8%，在匹配的敏感性下产生的假阳性和惰性（GG1）检测减少了约50%。配置为高灵敏度排除（90%-95%）的风险工具报告高阴性预测值（NPV）为97.5%至98.0%，并能够避免有意义的活检。在数字病理学中，独立评估Paige前列腺癌对核心活检的敏感性为97.7%，特异性为99.3%，而真实世界的部署减少了免疫组织化学要求、第二意见率和报告时间。总的来说，这些数据支持将人工智能部署为具有标准化采集和质量保证、本地校准和漂移监测的第二阅读器/分类器。优先证据需求包括多中心前瞻性研究和实用现实世界证据（RWE）报告患者结果和成本效益，并持续关注公平性、隐私性和法规遵从性。
{"title":"Artificial intelligence-driven prostate cancer diagnosis: Enhancing accuracy and personalizing patient care.","authors":"Xiaoyi Zhang, Na Xiao, Hao Liang, Peixin Li, Yaozhong Zhang, Shijie Zhang, Bin Zhou, Shengwen Yao, Zizhuo Yang, Jun Chen","doi":"10.1016/j.urolonc.2025.11.013","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.11.013","url":null,"abstract":"<p><p>Prostate cancer remains a major global burden; diagnostic pathways rely on prostate-specific antigen (PSA), multiparametric magnetic resonance imaging (mpMRI), and histopathology but face false positives, interobserver variability, and risk of overtreatment. We conducted a narrative review of peer-reviewed human studies (2015-February 2025; PubMed, Web of Science, Google Scholar) on artificial intelligence (AI) across imaging and digital pathology. Evidence shows that assistive AI can match or exceed expert performance while improving workflow. In a large international paired confirmatory study (PI-CAI), an MRI-based AI system achieved an area under the receiver operating characteristic curve (AUROC) of 0.91 versus 0.86 for 62 radiologists, detected 6.8% more Grade Group (GG) ≥2 cancers at matched specificity, and yielded ∼50% fewer false positives and 20% fewer indolent (GG1) detections at matched sensitivity. Risk tools configured for high-sensitivity rule-out (90%-95%) report high negative predictive value (NPV) 97.5% to 98.0% and enable meaningful biopsy avoidance. In digital pathology, independent assessments of Paige Prostate report 97.7% sensitivity and 99.3% specificity on core biopsies, while real-world deployments reduce immunohistochemistry requests, second-opinion rates, and reporting time. Collectively, these data support deploying AI as a second-reader/triage with standardized acquisition and quality assurance, local calibration, and drift monitoring. Priority evidence needs include multicenter prospective studies and pragmatic real-world evidence (RWE) reporting patient outcomes and cost-effectiveness, with continued attention to fairness, privacy, and regulatory compliance.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805636","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}
Pub Date : 2025-12-20DOI: 10.1016/j.urolonc.2025.11.018
Matthew L Hung, Robin Wang, Cathy Yu, Julie Kim, Alexander M Vezeridis, Andrew C Picel, Andrew J Gunn, Nishita Kothary
Purpose: To determine the efficacy and safety of sequential transarterial embolization and percutaneous cryoablation of renal masses > 3 cm.
Materials and methods: Forty six patients underwent sequential transarterial embolization and percutaneous cryoablation of a renal mass > 3 cm (31 patients with mass > 4 cm) at two tertiary academic medical centers between 2014 and 2024. Primary efficacy was defined as the percentage of target tumors with no evidence of residual enhancement following the initial procedure. Secondary efficacy included tumors that underwent successful repeat ablation after identifying local tumor progression. Adverse events were classified according to the Society of Interventional Radiology criteria. Kaplan-Meier survival analysis was utilized to determine progression-free survival rates.
Results: The median tumor diameter was 4.5 cm (IQR 3.5-5.3 cm). Primary and secondary efficacy rates for T1a lesions were 93% and 100%, respectively. Primary and secondary efficacy rates for T1b lesions were 81% and 87%, respectively. The 1-year and 2-year progression-free survival rates were 94% and 87%, respectively, after a median imaging follow-up period over 1.6 years (IQR 0.9-3.1). The overall adverse event rate was 13% (6/46) and the severe adverse event rate was 4% (2/46). Both severe adverse events were related to post-procedural hemorrhage.
Conclusion: Sequential transarterial embolization and percutaneous cryoablation is a technically feasible and effective treatment option with a low severe adverse event rate for renal masses > 3 cm.
目的：探讨经动脉序贯栓塞和经皮冷冻消融治疗肾肿物的疗效和安全性。材料和方法：2014年至2024年，在两个三级学术医疗中心，46例患者接受了连续经动脉栓塞和经皮冷冻消融肾肿块bbb3cm（31例为> 4cm）。初始疗效定义为在初始手术后没有残留增强证据的目标肿瘤的百分比。次要疗效包括在确定局部肿瘤进展后成功进行重复消融的肿瘤。不良事件按照介入放射学会的标准进行分类。Kaplan-Meier生存分析用于确定无进展生存率。结果：肿瘤中位直径4.5 cm （IQR 3.5 ~ 5.3 cm）。T1a病变的一次和二次有效率分别为93%和100%。T1b病变的原发性和继发性有效率分别为81%和87%。中位影像学随访时间超过1.6年（IQR 0.9-3.1）， 1年和2年无进展生存率分别为94%和87%。总不良事件发生率为13%(6/46)，严重不良事件发生率为4%（2/46）。两种严重不良事件均与术后出血有关。结论：序贯动脉栓塞加经皮冷冻消融术是治疗肾肿块技术上可行、有效且严重不良事件发生率低的方法。
{"title":"Efficacy and safety of sequential transarterial embolization and cryoablation of renal masses greater than 3 cm.","authors":"Matthew L Hung, Robin Wang, Cathy Yu, Julie Kim, Alexander M Vezeridis, Andrew C Picel, Andrew J Gunn, Nishita Kothary","doi":"10.1016/j.urolonc.2025.11.018","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.11.018","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the efficacy and safety of sequential transarterial embolization and percutaneous cryoablation of renal masses > 3 cm.</p><p><strong>Materials and methods: </strong>Forty six patients underwent sequential transarterial embolization and percutaneous cryoablation of a renal mass > 3 cm (31 patients with mass > 4 cm) at two tertiary academic medical centers between 2014 and 2024. Primary efficacy was defined as the percentage of target tumors with no evidence of residual enhancement following the initial procedure. Secondary efficacy included tumors that underwent successful repeat ablation after identifying local tumor progression. Adverse events were classified according to the Society of Interventional Radiology criteria. Kaplan-Meier survival analysis was utilized to determine progression-free survival rates.</p><p><strong>Results: </strong>The median tumor diameter was 4.5 cm (IQR 3.5-5.3 cm). Primary and secondary efficacy rates for T1a lesions were 93% and 100%, respectively. Primary and secondary efficacy rates for T1b lesions were 81% and 87%, respectively. The 1-year and 2-year progression-free survival rates were 94% and 87%, respectively, after a median imaging follow-up period over 1.6 years (IQR 0.9-3.1). The overall adverse event rate was 13% (6/46) and the severe adverse event rate was 4% (2/46). Both severe adverse events were related to post-procedural hemorrhage.</p><p><strong>Conclusion: </strong>Sequential transarterial embolization and percutaneous cryoablation is a technically feasible and effective treatment option with a low severe adverse event rate for renal masses > 3 cm.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805706","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}
Pub Date : 2025-12-19DOI: 10.1016/j.urolonc.2025.11.016
Taylor Goodstein M.D. , Eric A. Singer M.D., M.A., M.S., F.A.C.S., F.A.C.S.O.
{"title":"Editorial comment for “Neoadjuvant pembrolizumab and tyrosine kinase inhibitor to facilitate imperative partial nephrectomy for renal cell carcinoma”","authors":"Taylor Goodstein M.D. , Eric A. Singer M.D., M.A., M.S., F.A.C.S., F.A.C.S.O.","doi":"10.1016/j.urolonc.2025.11.016","DOIUrl":"10.1016/j.urolonc.2025.11.016","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 123.e17-123.e18"},"PeriodicalIF":2.3,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800772","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}
While some patients with metastatic renal cell carcinoma (mRCC) may experience an indolent disease progression and could benefit from deferred systemic therapy (ST), including active surveillance (AS) or metastasis-directed therapy (MDT), the evidence on its oncological efficacy and safety are still not well-established. We aimed to provide an overview of the available evidence on oncological outcomes of patients with mRCC undergoing deferred ST.
Methods
A systematic review of the literature was conducted in August 2024 using the PubMed, Scopus, and Embase databases to identify prospective and retrospective studies evaluating AS or deferred ST for patients with mRCC (PROSPERO ID: CRD42024579021). The co-primary outcomes were ST-free survival (ST-FS) and overall survival (OS). A random-effects model was used for quantitative analysis.
Key Findings and Limitations
We identified 15 eligible studies including 2,912 patients. Of these, 4 were prospective (n = 589 patients) and 11 were retrospective (n = 2,323 patients). The estimated 1-, 2-, 3-, 4-, and 5-year ST-FS rates (n = 1,070) were 74%, 54%, 49%, 43%, and 37%, respectively. The estimated 1-, 2-, 3-, 4-, and 5-year OS rates (n = 2,872) were 96%, 89%, 80%, 71%, and 69%, respectively. Key limitations at a study-level included selection bias, unmeasured confounding, and variability across deferred ST/AS protocols, including the indications for metastasis-directed therapy. Moreover, most studies used tyrosine kinase inhibitors as ST. The proportion of patients receiving MDT, including metastasectomy or stereotactic body radiation therapy, ranged from 14 to 100%.
Conclusions and Clinical Implications
Deferring ST by AS or MDT was associated with favorable oncological outcomes in carefully-selected patients with mRCC, highlighting the potential value of this approach in the contemporary multidisciplinary management of mRCC. Considering the limitations of available evidence and the lack of data on the oncological efficacy and safety of deferred ST for mRCC in the immune-oncology era, our review calls for further research in this field.
{"title":"Oncological outcomes of deferred systemic therapy for patients with metastatic renal cell carcinoma: A systematic review and quantitative analysis","authors":"Ichiro Tsuboi M.D. , Pawel Rajwa M.D. , Marcin Miszczyk M.D. , Tamás Fazekas M.D. , Akihiro Matsukawa M.D. , Mehdi Kardoust Parizi M.D. , Robert Schulz M.D. , Stefano Mancon M.D. , Ekaterina Laukhtina M.D. , Tatsushi Kawada M.D., Ph.D. , Satoshi Katayama M.D., Ph.D. , Takehiro Iwata M.D., Ph.D. , Kensuke Bekku M.D., Ph.D. , Koichiro Wada M.D., Ph.D. , Pierre I. Karakiewicz M.D., Ph.D. , Piotr Chlosta M.D., Ph.D. , Motoo Araki M.D., Ph.D. , Shahrokh F. Shariat M.D., Ph.D. , Riccardo Campi","doi":"10.1016/j.urolonc.2025.11.008","DOIUrl":"10.1016/j.urolonc.2025.11.008","url":null,"abstract":"<div><h3>Background and Objective</h3><div>While some patients with metastatic renal cell carcinoma (mRCC) may experience an indolent disease progression and could benefit from deferred systemic therapy (ST), including active surveillance (AS) or metastasis-directed therapy (MDT), the evidence on its oncological efficacy and safety are still not well-established. We aimed to provide an overview of the available evidence on oncological outcomes of patients with mRCC undergoing deferred ST.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was conducted in August 2024 using the PubMed, Scopus, and Embase databases to identify prospective and retrospective studies evaluating AS or deferred ST for patients with mRCC (PROSPERO ID: CRD42024579021). The co-primary outcomes were ST-free survival (ST-FS) and overall survival (OS). A random-effects model was used for quantitative analysis.</div></div><div><h3>Key Findings and Limitations</h3><div>We identified 15 eligible studies including 2,912 patients. Of these, 4 were prospective (<em>n</em> = 589 patients) and 11 were retrospective (<em>n</em> = 2,323 patients). The estimated 1-, 2-, 3-, 4-, and 5-year ST-FS rates (<em>n</em> = 1,070) were 74%, 54%, 49%, 43%, and 37%, respectively. The estimated 1-, 2-, 3-, 4-, and 5-year OS rates (<em>n</em> = 2,872) were 96%, 89%, 80%, 71%, and 69%, respectively. Key limitations at a study-level included selection bias, unmeasured confounding, and variability across deferred ST/AS protocols, including the indications for metastasis-directed therapy. Moreover, most studies used tyrosine kinase inhibitors as ST. The proportion of patients receiving MDT, including metastasectomy or stereotactic body radiation therapy, ranged from 14 to 100%.</div></div><div><h3>Conclusions and Clinical Implications</h3><div>Deferring ST by AS or MDT was associated with favorable oncological outcomes in carefully-selected patients with mRCC, highlighting the potential value of this approach in the contemporary multidisciplinary management of mRCC. Considering the limitations of available evidence and the lack of data on the oncological efficacy and safety of deferred ST for mRCC in the immune-oncology era, our review calls for further research in this field.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 92-101"},"PeriodicalIF":2.3,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752364","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":"Re-examining the predictive value of preoperative IL-6 in urothelial carcinoma: A constructive appraisal","authors":"Parth Aphale Ph.D., Himanshu Shekhar B.H.M.S., Shashank Dokania B.H.M.S.","doi":"10.1016/j.urolonc.2025.11.014","DOIUrl":"10.1016/j.urolonc.2025.11.014","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 116-117"},"PeriodicalIF":2.3,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757889","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}
Pub Date : 2025-12-11DOI: 10.1016/j.urolonc.2025.11.010
Pooja Gokhale Pharm.D., Akwasi Akosah Pharm.D., M.P.H., Lorenzo Villa Zapata Ph.D.
Immune-related adverse events (irAEs) are commonly associated with immune checkpoint inhibitor (ICI) therapy. ICIs are recommended at various stages of bladder cancer treatment, and appropriate management of irAEs is important in improving long-term outcomes in bladder cancer. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess irAEs associated with ICI therapy in bladder cancer. A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and Epistemonikos from inception till January 2025. The references of the included studies, clinicaltrials.gov, annual meeting abstracts of ASCO and ESMO, and the WHO International Clinical Trials Registry Platform were also searched for additional studies. Phase II or III randomized controlled trials (RCTs) where one of the experimental arms consisted of atezolizumab, pembrolizumab, nivolumab, or avelumab monotherapy were included. A Random effects model was used to conduct the meta-analysis in R Statistical Software, version 4.3.3. From the initial 1,092 articles screened, 12 were included in the systematic review and meta-analysis, comprising a total of 7,333 patients. Hypothyroidism (RR: 5.87 (3.23, 10.67)), hyperthyroidism (RR: 11.05 (4.20, 29.03)), pruritus (RR: 4.95 (2.82, 8.70)), rash (RR: 2.92 (1.51, 5.64)), colitis (RR: 2.15 (1.11, 4.15)), pneumonitis (RR: 3.91 (2.18, 7.02)), and nephritis (RR: 4.97 (1.43, 17.33)) were found to be significant irAEs associated with ICI therapy. Bladder cancer patients treated with ICIs are at significant risk of irAEs. These events vary in severity, and appropriate management of these adverse events should be prioritized to improve quality of life.
{"title":"Immune-related adverse events associated with immune checkpoint inhibitor therapy in bladder cancer patients: A systematic review and meta-analysis","authors":"Pooja Gokhale Pharm.D., Akwasi Akosah Pharm.D., M.P.H., Lorenzo Villa Zapata Ph.D.","doi":"10.1016/j.urolonc.2025.11.010","DOIUrl":"10.1016/j.urolonc.2025.11.010","url":null,"abstract":"<div><div>Immune-related adverse events (irAEs) are commonly associated with immune checkpoint inhibitor (ICI) therapy. ICIs are recommended at various stages of bladder cancer treatment, and appropriate management of irAEs is important in improving long-term outcomes in bladder cancer. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess irAEs associated with ICI therapy in bladder cancer. A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and Epistemonikos from inception till January 2025. The references of the included studies, clinicaltrials.gov, annual meeting abstracts of ASCO and ESMO, and the WHO International Clinical Trials Registry Platform were also searched for additional studies. Phase II or III randomized controlled trials (RCTs) where one of the experimental arms consisted of atezolizumab, pembrolizumab, nivolumab, or avelumab monotherapy were included. A Random effects model was used to conduct the meta-analysis in R Statistical Software, version 4.3.3. From the initial 1,092 articles screened, 12 were included in the systematic review and meta-analysis, comprising a total of 7,333 patients. Hypothyroidism (RR: 5.87 (3.23, 10.67)), hyperthyroidism (RR: 11.05 (4.20, 29.03)), pruritus (RR: 4.95 (2.82, 8.70)), rash (RR: 2.92 (1.51, 5.64)), colitis (RR: 2.15 (1.11, 4.15)), pneumonitis (RR: 3.91 (2.18, 7.02)), and nephritis (RR: 4.97 (1.43, 17.33)) were found to be significant irAEs associated with ICI therapy. Bladder cancer patients treated with ICIs are at significant risk of irAEs. These events vary in severity, and appropriate management of these adverse events should be prioritized to improve quality of life.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 79-91"},"PeriodicalIF":2.3,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744629","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}
Pub Date : 2025-12-10DOI: 10.1016/j.urolonc.2025.11.012
Amanda A. Myers M.D. , Zhigang Duan M.S. , Daniel A. Igel M.D. , Alexis R. Steinmetz M.D. , Valentina Grajales M.D. , Kelly K. Bree M.D. , Hui Zhao Ph.D. , Sharon H. Giordano M.D. , Ashish M. Kamat M.D.
Purpose
To analyze temporal trends in time intervals from hematuria diagnosis to urology evaluation and cystoscopy in patients with bladder cancer and identify opportunities for improved interventions.
Materials and Methods
We identified 84,515 Medicare beneficiaries in the SEER-Medicare database diagnosed with bladder cancer between 2005 and 2019, with hematuria claims within 12 months prior to diagnosis and urology visits thereafter. The co-primary outcome was delay (>30 days) and severe delay (>60 days) from hematuria claim to urology visit. The secondary outcome was delay (>14 days) and severe delay (>30 days) from urology visit to cystoscopy. We used joinpoint regression and logistic regression analyses.
Results
Delays from hematuria claim to urology visit increased over time; the proportion of patients experiencing a delay of over 30 days rose from 30.8% in 2005 to 35.1% in 2016, (Annual Percent Change (APC) 0.89%, P = NS).This trend accelerated significantly after 2016, reaching 39.2% in 2019 (APC 3.68%, P < 0.001). Females faced higher rates of delays throughout the study period. Females were 1.40 times more likely to experience a delay in their urology visit than males (aOR 1.40, 95% CI 1.34–1.46). Other variables associated with delay included Black and Hispanic race/ethnicity, not married, higher Charlson score, and residence. A preexisting relationship with a urologist reduced the delay likelihood (aOR 0.83, 95% CI 0.79–0.87).
Conclusions
Female patients continue to experience a disproportionately delayed urologic referral which has, unfortunately. worsened over time. To ensure equitable and timely diagnosis of bladder cancer, future interventions must focus on streamlining the initial referral process.
目的：分析膀胱癌患者从血尿诊断到泌尿科评估和膀胱镜检查的时间间隔趋势，并确定改进干预措施的机会。材料和方法：我们在SEER-Medicare数据库中确定了2005年至2019年间诊断为膀胱癌的84,515名医疗保险受益人，在诊断前12个月内有血尿索赔，此后有泌尿科就诊。共同主要结局是从血尿索赔到泌尿科就诊的延迟（bbb30天）和严重延迟（>60天）。次要结局是延迟（>14天）和严重延迟（>30天）从泌尿外科就诊到膀胱镜检查。我们使用联结点回归和逻辑回归分析。结果：血尿延迟到泌尿科就诊的时间随时间增加；延迟30天以上的患者比例从2005年的30.8%上升到2016年的35.1%,（年度百分比变化（APC） 0.89%, P = NS）。这一趋势在2016年之后显著加速，2019年达到39.2% （APC为3.68%,P < 0.001）。在整个研究期间，女性面临更高的延迟率。女性在泌尿科就诊延迟的可能性是男性的1.40倍（aOR 1.40, 95% CI 1.34-1.46）。其他与延迟相关的变量包括黑人和西班牙裔种族/民族、未婚、较高的查尔森评分和居住地。先前与泌尿科医生的关系降低了延迟的可能性（aOR 0.83, 95% CI 0.79-0.87）。结论：女性患者继续经历不成比例的延迟泌尿科转诊，不幸的是。随着时间的推移而恶化。为了确保膀胱癌的公平和及时诊断，未来的干预措施必须侧重于简化最初的转诊过程。
{"title":"Disparities and temporal trends in referral for bladder cancer diagnosis: A worsening epidemic","authors":"Amanda A. Myers M.D. , Zhigang Duan M.S. , Daniel A. Igel M.D. , Alexis R. Steinmetz M.D. , Valentina Grajales M.D. , Kelly K. Bree M.D. , Hui Zhao Ph.D. , Sharon H. Giordano M.D. , Ashish M. Kamat M.D.","doi":"10.1016/j.urolonc.2025.11.012","DOIUrl":"10.1016/j.urolonc.2025.11.012","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze temporal trends in time intervals from hematuria diagnosis to urology evaluation and cystoscopy in patients with bladder cancer and identify opportunities for improved interventions.</div></div><div><h3>Materials and Methods</h3><div>We identified 84,515 Medicare beneficiaries in the SEER-Medicare database diagnosed with bladder cancer between 2005 and 2019, with hematuria claims within 12 months prior to diagnosis and urology visits thereafter. The co-primary outcome was delay (>30 days) and severe delay (>60 days) from hematuria claim to urology visit. The secondary outcome was delay (>14 days) and severe delay (>30 days) from urology visit to cystoscopy. We used joinpoint regression and logistic regression analyses.</div></div><div><h3>Results</h3><div>Delays from hematuria claim to urology visit increased over time; the proportion of patients experiencing a delay of over 30 days rose from 30.8% in 2005 to 35.1% in 2016, (Annual Percent Change (APC) 0.89%, <em>P</em> = NS).This trend accelerated significantly after 2016, reaching 39.2% in 2019 (APC 3.68%, <em>P</em> < 0.001). Females faced higher rates of delays throughout the study period. Females were 1.40 times more likely to experience a delay in their urology visit than males (aOR 1.40, 95% CI 1.34–1.46). Other variables associated with delay included Black and Hispanic race/ethnicity, not married, higher Charlson score, and residence. A preexisting relationship with a urologist reduced the delay likelihood (aOR 0.83, 95% CI 0.79–0.87).</div></div><div><h3>Conclusions</h3><div>Female patients continue to experience a disproportionately delayed urologic referral which has, unfortunately. worsened over time. To ensure equitable and timely diagnosis of bladder cancer, future interventions must focus on streamlining the initial referral process.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 120.e1-120.e11"},"PeriodicalIF":2.3,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744615","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}
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