Urologic Oncology-seminars and Original Investigations最新文献

{"title":"Integrated care among patients with kidney or urinary bladder cancer: An NCI patterns-of-care analysis","authors":"Kirsten Y. Eom Ph.D., M.P.H. ,&nbsp;Bhupinder Mann M.B.B.S. ,&nbsp;Michael T. Halpern M.D., Ph.D., M.P.H.","doi":"10.1016/j.urolonc.2024.11.012","DOIUrl":"10.1016/j.urolonc.2024.11.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Cancer patients often have complex medical needs from diagnosis to survivorship/end-of-life care. Integrated care, including care coordination, multidisciplinary rounds, and supportive care services, is crucial for high-quality cancer care. Yet, factors influencing integrated care receipt are not well understood. This study describes patterns of integrated care among individuals diagnosed with kidney or urinary bladder cancer and examines patient- and hospital-level factors associated with these services.</div></div><div><h3>Methods</h3><div>Analyzing 2019 National Cancer Institute Patterns-of-Care data, we assessed integrated care service receipt among stage I to IV kidney and stage 0a to IVb urinary bladder cancer patients aged ≥ 20 years using a stratified Surveillance, Epidemiology, and End Results registry sample. Integrated care services within 12 months postdiagnosis were identified by medical record abstraction. Multivariable logistic regression analyses identified patient, clinical, and hospital-level factors significantly associated with receipt of integrated care.</div></div><div><h3>Results</h3><div>Significant variations in receiving integrated care were observed based on insurance status; uninsured patients less likely to receive these services. Racial/ethnic differences were also noted, as non-Hispanic white patients had higher likelihoods of receiving integrated care. Stage IV kidney cancer patients were 2.63 times [1.44–4.79] more likely to receive integrated care than stage I patients. Treatment characteristics and hospital-level factors appeared to have minimal impact on receiving these services.</div></div><div><h3>Conclusion</h3><div>The lower likelihood of receiving integrated care among patients with no insurance and among certain racial/ethnic groups underscores gaps in equitable access to patient-centered cancer care. Future research should include patient perspectives to enhance understanding of unmet needs and influencing factors related to integrated care services.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 191.e13-191.e27"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808172","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":"IDENTIFICATION OF OVER 40 NOVEL TESTICULAR GERM CELL TUMOR SUSCEPTIBILITY LOCI","authors":"John Pluta,&nbsp;Kristian Almstrup,&nbsp;Darren Feldman,&nbsp;Victoria Cortessis,&nbsp;Alberto Ferlin,&nbsp;Jourik Gietema,&nbsp;Anna Gonzalez,&nbsp;Rob Hamilton,&nbsp;Trine Haugen,&nbsp;Lambartus Kiemeny,&nbsp;Csilla Krausz,&nbsp;Davor Lessel,&nbsp;Katherine McGlynn,&nbsp;Kevin Nead,&nbsp;Jeremie Nsengimana,&nbsp;Jen Poynter,&nbsp;Thorunn Rafnar,&nbsp;Lorenzo Richiardi,&nbsp;Stephen Schwartz,&nbsp;Rolf Skotheim,&nbsp;Katherine Nathanson","doi":"10.1016/j.urolonc.2024.12.087","DOIUrl":"10.1016/j.urolonc.2024.12.087","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;In the United States, testicular germ cell tumors (TGCT) are the most common cancers in young men with an incidence that has doubled over the past 20 years. TGCT is the most heritable of all cancers. Genome-wide association studies (GWAS) of TGCT led by the Testicular Cancer Consortium (TECAC) have identified variants of moderate effect that explain a large proportion of the high heritability of disease. Identified loci to date implicate genes in pathways associated with male germ cell development, chromosomal segregation, sex determination, and DNA maintenance, together which help to frame the disease biology and epidemiology. The existing polygenic risk scores (PRS) can identify men at 7-fold increased risk of developing TGCT. We present preliminary findings from our current TECAC GWAS meta-analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Genotype data on 13,667 men with and 220,834 men without TGCT from 11 independent study samples were analyzed. For each study sample, genotypes passing standard SNP- and sample-level quality control were imputed against the Haplotype Reference Consortium r1.1 backbone, and SNP-level quality control was repeated after imputation. Association testing for common variation (MAF ≥ 0.05) was performed using SNPTEST v2.5.6. Meta-analysis with inverse-variance weighting of study-specific summary statistics was performed using METAL r2020.5.5. Genetic markers with significant effect size heterogeneity across studies (p &lt;1×10&lt;sup&gt;-05&lt;/sup&gt;) were removed from further consideration. We are in the process of updating our meta-analysis to include an additional study sample of 3,332 men with and 1,397 men without TGCT for whom low-pass whole genome sequencing (WGS) data was generated by TECAC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Preliminary results identified 39 novel loci. The most significant locus (rs5987215; p = 1.46 10-15) is intergenic between MECP2 and OPN1LW. Several loci map to genes in known TGCT susceptibility pathways, including male germ cell development and sex differentiation (WT1: rs72908940, &lt;em&gt;p&lt;/em&gt; = 2.93 10&lt;sup&gt;-8&lt;/sup&gt;; &lt;em&gt;WNK1&lt;/em&gt;: rs2277869, &lt;em&gt;p&lt;/em&gt; = 1.05 10&lt;sup&gt;-9&lt;/sup&gt;; &lt;em&gt;GATA4&lt;/em&gt;: rs3203358, &lt;em&gt;p&lt;/em&gt; = 1.70 10&lt;sup&gt;-8&lt;/sup&gt;; &lt;em&gt;PRC1&lt;/em&gt;: rs7167128, &lt;em&gt;p&lt;/em&gt; = 9.21 10&lt;sup&gt;-11&lt;/sup&gt;; &lt;em&gt;REXO1&lt;/em&gt;: rs28626548, &lt;em&gt;p&lt;/em&gt; = 4.05 10&lt;sup&gt;-9&lt;/sup&gt;), chromosomal segregation (&lt;em&gt;MEI1&lt;/em&gt;: rs5758426, &lt;em&gt;p&lt;/em&gt; = 2.93 10&lt;sup&gt;-8&lt;/sup&gt;; &lt;em&gt;MAPT&lt;/em&gt;: rs17662403, &lt;em&gt;p&lt;/em&gt; = 3.50 10&lt;sup&gt;-13&lt;/sup&gt;), and RNA transcription (&lt;em&gt;ZNF638&lt;/em&gt;: rs6725892, &lt;em&gt;p&lt;/em&gt; = 8.26 10&lt;sup&gt;-10&lt;/sup&gt;; &lt;em&gt;TBLP2&lt;/em&gt;: rs4901569, &lt;em&gt;p&lt;/em&gt; = 2.28 10&lt;sup&gt;-8&lt;/sup&gt;; &lt;em&gt;CNOT2&lt;/em&gt;: rs4901569, &lt;em&gt;p&lt;/em&gt; = 4.25 10&lt;sup&gt;-9&lt;/sup&gt;; &lt;em&gt;ZNF552&lt;/em&gt;: rs140089558, &lt;em&gt;p&lt;/em&gt; = 2.74 10&lt;sup&gt;-12&lt;/sup&gt;). Three novel independent markers map to the androgen receptor region (rs4240053, &lt;em&gt;p&lt;/em&gt; = 7.75 10&lt;sup&gt;-12&lt;/sup&gt;; rs12390145, &lt;em&gt;p&lt;/em&gt; = 6.80 10&lt;sup&gt;-14&lt;/sup&gt; ; rs17216906, &lt;em&gt;p&lt;/em&gt; =","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 34-35"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143508664","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":"QUANTIFYING THE BENEFIT OF SALVAGE RADIATION THERAPY FOR BIOCHEMICALLY RECURRENT PROSTATE CANCER AFTER RADICAL PROSTATECTOMY","authors":"Spyridon Basourakos,&nbsp;Stephen Boorjian,&nbsp;Phillip Schulte,&nbsp;Grant Henning,&nbsp;Jamie O'Byrne,&nbsp;Matthew Tollefson,&nbsp;Igor Frank,&nbsp;Abhinav Khanna,&nbsp;Ryan Phillips,&nbsp;Bradley Stish,&nbsp;R. Jeffrey Karnes,&nbsp;Vidit Sharma","doi":"10.1016/j.urolonc.2024.12.012","DOIUrl":"10.1016/j.urolonc.2024.12.012","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The natural history of biochemical recurrence (BCR) after radical prostatectomy (RP) is heterogeneous and may be quite prolonged. As such, determining the impact of salvage radiation therapy (SRT) remains challenging, particularly in the absence of prospective randomized trials with a comparator observation control arm. While “early” SRT at PSA &lt;0.5ng/mL is supported by guidelines based on demonstrated favorable metastasis outcomes, lower PSAs also portend a more favorable prognosis for untreated BCR. Herein, therefore, we employ a time-dependent propensity score-matched analysis to quantify the oncologic benefit of SRT relative to observation for men with BCR after RP.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We queried our institutional RP registry from 1990-2017 (n=20,688) to identify patients who developed BCR (PSA≥0.2ng/mL). We performed risk-set matching using a time-dependent propensity score. The propensity to receive SRT after BCR was estimated using Cox regression, including covariates at BCR (baseline, time zero) and time-dependent covariates after BCR. Covariates in the Cox regression model were selected &lt;em&gt;a priori&lt;/em&gt; based on suspected relationships as potential confounders, including time-independent covariates defined at surgery or at BCR (time zero). These included age at BCR, surgery year, time from surgery to BCR, Gleason score, T-stage, N-stage and margin status at the time of RP. We also included time-dependent covariates ascertained after BCR, including PSA value, log PSA, highest postoperative PSA, and count of PSA values measured since RP. SRT patients were matched to patients with BCR who did not receive SRT to compare the incidence of systemic progression. The number needed to treat (NNT) with SRT to prevent a metastasis at 10 years was calculated as well. Interaction analyses were performed to identify factors that modify the effect size of SRT on metastasis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 6,881 patients developed BCR, of whom 2109 received SRT. Patients managed with SRT were younger, had higher pathologic Gleason score, and a higher incidence of positive nodes. Median follow-up after BCR was 9.8 years (IQR 5.3, 15.7) during which 947 patients developed systemic progression. After 1:1 propensity score matching (with 2109 patients per cohort), absolute standardized differences in clinicopathologic characteristics between cohorts were negligible (&lt;strong&gt;Table&lt;/strong&gt;). SRT was associated with a lower risk of systemic progression compared to observation at 10 years (22% vs 29%, p&lt;0.001) (&lt;strong&gt;Figure&lt;/strong&gt;). SRT remained independently associated with a decreased risk of systemic progression on regression (HR 0.71, 95%CI 0.60–0.85, p&lt;0.001), translating to an NNT with SRT of 14 (95%CI 11-21) to prevent one case of systemic progression at 10 years after BCR. A significant interaction was identified between PSA at SRT and the association with metastasis (p-interac","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 4"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509348","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":"FACTORS ASSOCIATED WITH PROSTATE CANCER SCREENING AMONG HISPANIC MEN: RESULTS FROM HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL)","authors":"Aysswarya Manoharan,&nbsp;Blanca Noriega Esquives,&nbsp;Frank Penedo,&nbsp;Helen Hougen","doi":"10.1016/j.urolonc.2024.12.029","DOIUrl":"10.1016/j.urolonc.2024.12.029","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Known disparities exist in prostate cancer (PCa) treatment and outcome among Hispanic men. Hispanic men are significantly more likely to present with more advanced prostate cancer than non-Hispanic whites. Unequal access to early prostate cancer detection may result in higher rates of prostate cancer diagnoses at an advanced stage. Currently, little is known regarding the pattern of prostate cancer screening among Hispanic men. We aimed to determine the prostate cancer screening rate among Hispanic men and identify sociodemographic, cultural, psychosocial, medical, and healthcare access predictors associated with prostate cancer screening.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a prospective, population-based multicenter observational study of Hispanic adults recruited from four US metropolitan areas (Bronx, NY; Miami, FL; San Diego, CA; Chicago, IL). We included Hispanic men 40+ years who participated in the study between 2014-2017. Our primary outcome was self-reported receipt of a PSA blood test. We excluded those with a prior prostate cancer diagnosis or a missing value for the outcome variable. All analyses were stratified by age categories (ages 40-54, 55-69, and 70+) and incorporated weights for sampling, stratification, and clustering to account for the HCHS/SOL complex survey design. Associations between participant characteristics and PSA screening rates were examined using t-tests and chi-squared tests. Weighted logistic regression models were used to examine the rates of PSA screening along with odds of having a PSA test given demographic, cultural, psychosocial, medical, and healthcare utilization factors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our cohort included 3,484 diverse Hispanic men (Table 1) whose PSA screening rates were analyzed by race/nationality (Figure 1). PSA screening increased with age (40-54 years: 20%, 55-69 years: 46%, and 70+ years: 56%, &lt;em&gt;p&lt;/em&gt;&lt;0.001). Black Hispanic men have the lowest odds of screening (OR 0.24 95%CI: 0.07-0.86, &lt;em&gt;p&lt;/em&gt;=0.028 for ages 40-54 and OR 0.31 95%CI: 0.11-0.91, &lt;em&gt;p&lt;/em&gt;=0.033 for ages 55-69). Cuban men had the lowest odds of screening (OR 0.41 for ages 55-69 and OR 0.32 for ages 70+). For men aged 40-54, lower family cohesion, lower chronic stress, and not having a primary doctor predicted lack of PSA screening. For men aged 55-69, lower BMI, low social support, not having a personal doctor, and remote check-up predicted lack of PSA screening. For men aged 70+, odds of screening decreased with low education attainment and not having a personal doctor.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Among Hispanic men, a low rate of guideline-appropriate PSA screening and significant heterogeneity exist. Black Hispanics consistently have the lowest rate of PSA screening in our population. Men of Cuban heritage ages 55-69 had the lowest screening rates. Poor primary health access is also s","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 11"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509709","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":"SINGLE-ARM PHASE II STUDY OF NEOADJUVANT INTENSIFIED ANDROGEN DEPRIVATION IN COMBINATION WITH AKT INHIBITION (CAPIVASERTIB) FOR HIGH-RISK LOCALIZED PROSTATE CANCER WITH PTEN LOSS (SNARE)","authors":"Ryan Kopp,&nbsp;George Thomas,&nbsp;Robert Bruce Montgomery,&nbsp;Matthew Rettig,&nbsp;Izak Faiena,&nbsp;Antonio Tito Fojo,&nbsp;Yun Yu,&nbsp;Rochelle Fu,&nbsp;Mark Garzotto,&nbsp;Julie Graff","doi":"10.1016/j.urolonc.2024.12.009","DOIUrl":"10.1016/j.urolonc.2024.12.009","url":null,"abstract":"<div><h3>Introduction</h3><div>High-risk prostate cancers (PCa) treated surgically commonly exhibit loss of the phosphatase and tensin homologue (PTEN) tumor suppressor gene, which leads to increased activity of the protein kinase B (AKT) signaling pathway. PTEN loss is associated with higher rates of PCa recurrence, metastasis, and cancer mortality. Manipulation of androgen receptor (AR) pathway to reduce mortality has been a focus of PCa therapy for decades; however, PTEN loss is a lead mechanism for PCa resistance to AR directed therapy and development of castrate resistant PCa. Pre-clinical research identified a reciprocal feedback regulation between the PTEN/AKT signaling axis and the AR signaling axis that could be overcome by blocking both pathways. This study will perform a single arm Phase II trial combining intensified androgen deprivation (iADT; abiraterone and leuprolide) with AKT inhibition (AKTi, capivasertib) prior to radical prostatectomy among high-risk localized prostate cancers with PTEN loss.</div></div><div><h3>Methods</h3><div>The SNARE trial (NCT05593497) is a Veterans Affairs (VA) multicenter, single arm phase II study for neoadjuvant iADT with capivasertib with integral biomarker design. Key eligibility includes high-risk PCa defined as ≥1 criterion: resectable cT3; Grade Group ≥4; Memorial Sloan Kettering nomogram 5-year progression free probability ≤50% with either PSA &gt;20 ng/ml or Grade Group 3. Subjects must have ≤10% PTEN staining (central IHC). Intervention includes iADT 4-week run-in, tumor biopsy (for molecular correlates), 16 weeks combined iADT with AKTi, then radical prostatectomy. The primary endpoint is pathological response (pT0 or minimal residual disease ≤5mm, central review). We will screen 160 subjects (estimate PTEN loss in 20%) to enroll 30 participants to compare 20% pathological response vs. null hypothesis of 5% (historical ADT alone). Secondary endpoints include medical and surgical safety and molecular correlates (DNA, RNA, Nanostring DSP protein) with response. SNARE is currently open to enrollment at 4 sites.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 3"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509843","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":"GENE EXPRESSION DIFFERENCES AND PATHWAY ACTIVATION BY RACE IN ERG+ PROSTATE CANCERS: IMPLICATIONS FOR EQUITABLE CANCER CARE","authors":"Matthew W. Cole,&nbsp;Keavash Assani,&nbsp;Bryn Launer,&nbsp;Hunter Robinson,&nbsp;Avi Baskin,&nbsp;Nikita Bastin,&nbsp;Matthew Shou,&nbsp;Derick Zhang,&nbsp;Janene Pierce,&nbsp;Jeffrey Tosoian","doi":"10.1016/j.urolonc.2024.12.015","DOIUrl":"10.1016/j.urolonc.2024.12.015","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;A large body of evidence has demonstrated increased prostate cancer (PCa) incidence and mortality in African-American (AA) men relative to White men. While outcome disparities are strongly influenced by social determinants of health, established differences in molecular tumor biology between AA and White men have implications across the spectrum of prostate cancer care, including early diagnostic testing and targeted therapeutics. Expression of the &lt;em&gt;ERG&lt;/em&gt; gene (ERG+) is an early molecular alteration in one-half of prostate cancers. Additionally, ERG+ is found to be two-fold more prevalent in White men compared to AA men. However, downstream molecular differences by race remain poorly understood. In a diverse cohort of men with ERG+ prostate cancer, we sought to assess differential expression of PCa-associated genes and identify specific biologic pathways implicated in AA PCa.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Using the publicly available GSE169038 dataset, we analyzed Decipher whole-transcriptome expression profiles (22,236 transcripts) in 1079 men with clinically significant PCa (Grade Group ≥ 2) who underwent radical prostatectomy. Tumors were designated as either ERG+ or ERG- via Gaussian Mixture Modeling, and differentially expressed genes were identified among sample groups using the linear models for microarray data (&lt;em&gt;Limma&lt;/em&gt;) package with a false discovery rate (FDR) threshold of 5%. Gene Set Enrichment Analysis (GSEA) was performed on differentially expressed genes using the EnrichR web-based tool with an FDR threshold of 10%. Correction for multiple comparisons was performed using the Benjamini-Hochberg method.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The microarray analysis included 522 White and 557 AA men. Overall, 40% (n=209) of White patients were classified as ERG+, as compared to 23% (n=127) of AA patients (p&lt;0.001). A total of 5814 genes were differentially expressed in ERG+ tumors relative to ERG- tumors. Of these, 2605 (45%) genes were differentially expressed in both White and AA patients. Additionally, 1987 (34%) genes were differentially expressed in only White patients, and 1312 (23%) were differentially expressed in only AA patients. Enrichment signatures in the genes that were differentially expressed in both White and AA patients demonstrated significant associations with pathways related to androgen and estrogen response, fatty acid metabolism, and apoptosis (q&lt;0.05 for all). In addition to the above shared pathways, genes differentially expressed only in White patients were associated with the p53 (q=0.04), while genes differentially expressed solely in AA patients were associated with the E2F Target pathway (q=0.07).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our analysis revealed distinct genetic profiles between White and AA patients within the ERG+ PCa molecular subtype. As previously described, we found ERG upregulation was associated with dysregulation of the androgen","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 5-6"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509846","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":"MAPPING PATTERNS OF RECURRENCE AFTER SALVAGE LYMPH NODE DISSECTION IN PATIENTS WITH METASTATIC PROSTATE CANCER","authors":"Mohamed E. Ahmed,&nbsp;Giuseppe Reitano,&nbsp;Milad Bonakdarhashemi,&nbsp;Kelly Lehner,&nbsp;Carter Day,&nbsp;Jack Andrews,&nbsp;Eugene Kwon,&nbsp;R. Jeffrey Karnes","doi":"10.1016/j.urolonc.2024.12.071","DOIUrl":"10.1016/j.urolonc.2024.12.071","url":null,"abstract":"<div><h3>Introduction</h3><div>Salvage lymph node dissection represents one of the rescue treatment options for prostate cancer patients with lymph node recurrence. Nonetheless, patterns of recurrence after salvage lymph node dissection is not well stuided. As such, we thought to study patterns of recurrence in patients with oligometastatic disease identified through C11 choline PET imaging and treated with salvage lymph node dissection.</div></div><div><h3>Methods</h3><div>Utilizing the prospectively maintained C11 choline PET CT scan registry, we identified 116 patients who underwent salvage lymph node dissection for oligometastatic disease detected by C11 choline PET/CT. The salvage lymph node dissection procedures included a bilateral extended template. Recurrence sites following the procedure were classified into five categories: local recurrence, regional lymph node recurrence, non-regional lymph node recurrence, distant recurrence, and bone disease. The median follow-up duration was 90 months.</div></div><div><h3>Results</h3><div>Table 1 presents the clinicopathological variables of the study cohort. Notably, 88% of the cohort had undergone radical prostatectomy as their primary treatment. The majority of patients had 1-2 pathology-proven metastases on C11 choline PET-CT prior to salvage lymph node dissection. Regional lymph nodes were the predominant site of pre-salvage oligometastatic disease, accounting for 70% of cases. Figure 1 illustrates the sites of disease recurrence following salvage lymph node dissection. Regional lymph nodes were the most common site of recurrence, followed by bone disease, non-regional lymph nodes, local recurrence, and distant lymph node metastases. The median time to biochemical recurrence after salvage lymph node dissection was approximately 9 months.</div></div><div><h3>Conclusions</h3><div>Salvage lymph node dissection constitutes one of the salvage treatment options for patients with oligometastatic disease. Presents of recurrence after salvage lymph node dissection is anatomically diverse with regional lymph node represents the most common site of disease recurrence. This findings have implications for guiding subsequent salvage treatment options after salvage lymph node dissections.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 28"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509872","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":"A PHASE 3 STUDY OF 177LU-TLX591 PLUS SOC VS SOC ALONE IN PATIENTS WITH MCRPC (PROSTACT GLOBAL)","authors":"Oliver Sartor,&nbsp;Nat Lenzo,&nbsp;David Cade,&nbsp;Neeraj Agarwal","doi":"10.1016/j.urolonc.2024.12.007","DOIUrl":"10.1016/j.urolonc.2024.12.007","url":null,"abstract":"<div><h3>Introduction</h3><div>The treatment of advanced prostate cancer (PC) is challenging, with no curative therapy to date and undesirable side effects that may impact patient quality of life. Monoclonal antibodies enable high specificity with low rates of off-target organ exposure, prolonged retention in PSMA+ tumors, and a predictable safety profile. There is a strong rationale for further investigation of the ¹⁷⁷Lu-labeled, chelator-conjugated antibody, ¹⁷⁷Lu-DOTA-rosopatamab (hereafter, TLX591), with prior studies demonstrating favorable safety and efficacy, particularly with a fractionated (dose-dense) regimen. Phase 1 ProstACT SELECT preliminary results demonstrate consistent uptake between TLX591 and ⁶⁸Ga-PSMA-11 imaging and reinforces advantages of this first-in-class radio-antibody drug conjugate investigational therapy. This multinational, multicenter, prospective, randomized, open label phase 3 study will expand the study of TLX591 in patients with PSMA-expressing metastatic castration-resistant PC (mCRPC) that have progressed despite prior treatment with an androgen-receptor pathway inhibitor (ARPI).</div></div><div><h3>Methods</h3><div>Patients will be enrolled in 1) a safety and dosimetry lead-in (N=30) and 2) a randomized treatment expansion (N=400) in a 2:1 ratio to receive best protocol-defined standard of care (SoC) with or without 2 intravenous injections of 2.8 GBq TLX591, given 14 days apart. SoC may be an alternative ARPI or docetaxel. Eligible patients must have received 1 prior ARPI in the mCRPC setting. Patients must have 150x10⁹ /L platelets and have PSMA-positive disease on ⁶⁸Ga-PSMA-11 PET/CT imaging.</div><div>The primary endpoint is radiographic progression-free survival. Secondary endpoints include 5-year overall survival, tumor objective response rate, time to symptomatic skeletal event, health-related quality of life, and treatment-related adverse events count. An alpha control and 95% confidence intervals will be used; patients will be sub-stratified between TLX591 + 2^nd ARPI or TLX591 + docetaxel. This study is currently enrolling.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 2"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509954","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":"CANCER CENTER AFFILIATION ASSOCIATED WITH IMPROVED SURVIVAL FOR GENITOURINARY CANCERS AT SAFETY NET HSOPITALS","authors":"Raj Bhanvadia,&nbsp;Kris Gaston,&nbsp;Solomon Woldu,&nbsp;Yair Lotan,&nbsp;Vitaly Margulis","doi":"10.1016/j.urolonc.2024.12.032","DOIUrl":"10.1016/j.urolonc.2024.12.032","url":null,"abstract":"<div><h3>Introduction</h3><div>Safety net hospitals (SNH) care for a substantial proportion of vulnerable populations. Addressing health disparities at a hospital level through strategic partnerships with cancer centers is a potential strategy to improve outcomes of vulnerable populations. We thus compared outcomes for metastatic prostate (mPCa), kidney (mKCa), and urothelial cancer (mUC) among national cancer institute (NCI) centers, NCI affiliated SNHs (NCI-SNH), and non-affiliated SNHs using the Texas Cancer Registry (TCR).</div></div><div><h3>Methods</h3><div>The TCR has 98% case ascertainment of all cancers diagnosed in Texas. The TCR can identify each facility a patient was diagnosed and treated, allowing detailed hospital level comparisons of outcomes. The TCR was queried from 2004-2017 for mPCa, mKCa, and mUC. Publicly available data identified Texas NCI cancer centers. The top quartile of Disproportionate Share Hospital Index values identified SNHs. Safety net hospitals with established relationships with NCI centers were designated as NCI-SNH's while the remainder were SNHs. Hospitals not affiliated with NCI centers or defined as SNH's were non-SNHs. Vulnerable populations were defined as age &gt; 75, non-US natives, non-whites, and uninsured or Medicaid patients. Cox multivariable regression was used to assess survival by cancer type and hospital designation.</div></div><div><h3>Results</h3><div>The TCR identified 20,503 metastatic genitourinary (GU) cancers. MPCa comprised 47.7% of cases, followed by mKCa (41.2%), and mUC (11.1%). NCI centers accounted for 18.6% of cases, and NCI-SNH accounted for 5.3% of cases. Most patients seen at NCI-SNH's were identified as medically vulnerable (84.6%, <em>p</em>&lt;0.01) compared to NCI (41.2%), other SNH (58.6%) or non-SNH (58.6%). For mPCa, rates of systemic hormone therapy were similar between NCI-SNH (76.7%) and NCI (76.2%), but significantly greater than SNH (51.5%) or non-SNH (49.7%). Receipt of chemotherapy or immunotherapy was greater at NCI-SNHs compared to other SNHs or non-SNH's for both mKCa (36.1% vs 31.1% vs 27.1%, <em>p</em>&lt;0.01) and mUC (44.0% vs 36.7% vs 33.2%, <em>p</em>&lt;0.01). On multivariable cox analysis, overall mortality was significantly lower at NCI-SNHs for mPCa, mKCa, and mUC compared to Non-SNHs and equivalent to NCI centers (Table 1).</div></div><div><h3>Conclusions</h3><div>NCI affiliated SNHs accounted for a large proportion of vulnerable patient cancer care within their systems. NCI-SNHs had a greater proportion of patients receive systemic therapies for metastatic GU cancers than other SNH's. Further, NCI-SNHs had superior survival compared to other SNHs and equivalent survival to NCI centers. Future initiatives to improve cancer care should focus on strengthening existing relationships between NCI centers and SNHs, and mechanisms to improve centralization of care of vulnerable populations to these facilities.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Pages 12-13"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509964","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":"TEACHING ADVANCED SURGICAL TECHNIQUE USING PEER-REVIEWED MULTIMEDIA: AN ASSESSMENT OF TECHNICAL COMPETENCE IN CADAVERIC-BASED SIMULATION","authors":"Pocharapong Jenjitranant,&nbsp;Tyler S. Beveridge,&nbsp;Melissa Huynh,&nbsp;Nicholas E. Power","doi":"10.1016/j.urolonc.2024.12.079","DOIUrl":"10.1016/j.urolonc.2024.12.079","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Retroperitoneal lymph node dissection (RPLND) is a highly effective surgery for the removal of testicular cancer metastases, with high cure rates and minimal risk when performed in expert centers. Despite this, some risk of postoperative functional infertility is still associated with RPLND when unintentional and preventable damage is caused to an intricate network of nerves. This is a particularly concerning complication given that testicular cancer primarily affects young males. Nerve-sparing RPLND is a rare and complex surgical procedure that can reduce the risk of this complication. However, it's also a procedure that most surgical trainees have limited exposure to. Therefore, we created expert-designed video learning material for the teaching of nerve-sparing RPLND. When used in combination with human cadaveric simulation, we believe that this video learning material can improve the surgical performance of trainees in this rare and complex procedure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A group of 10 participants was recruited for a prospective study in which the performance of the nerve-sparing RPLND procedure by those participants was assessed both before and after watching expert-designed video learning material of the surgery. All of the participants were urology residents and fellows that were tasked with performing the procedure on either fresh or soft human cadavers before exposure to the video (unilateral portion) and again after exposure to it (contralateral portion). Their surgical performance was quantitatively assessed for operative time and percentage of lymph node (LN) mass resected and video-recorded for further qualitative assessment by a blinded expert surgeon using generic Objective Structured Assessment of Technical Skills (OSATS) and procedure-specific rating scales. Participants also completed a self-assessment of qualitative measures including for efficiency, technique, thoroughness (completeness of LN resection), quality (viability of nerve), and comfort level.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The participants were randomized to perform either left-sided or right-sided RPLND first. The mean generic OSATS global rating scale (20.40 vs. 16.00, p&lt;0.001), completeness of LN dissection score (3.63 vs. 2.38, p=0.007), preservation of nerve integrity score (3.63 vs. 2.08, p=0.010), and percentage of LN mass resected (81.57% vs. 52.07%, p&lt;0.001) significantly increased in the second surgery. The mean self-assessment scores significantly improved in all aspects, including efficiency (51.40 vs. 24.20, p=0.003), technique (50.40 vs. 30.40, p=0.007), thoroughness (48.60 vs. 25.90, p&lt;0.001), quality (45.20 vs. 20.10, p=0.003), and comfort level (61.00 vs. 24.90, p=0.002). The participants who performed the left-sided RPLND first had significantly higher mean improvement of the percentage of LN mass resected (43.12% vs. 15.88%, p=0.003) and completeness of LN dissection score (2.05 vs. 0.4","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 3","pages":"Page 31"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510053","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}