Pub Date : 2025-10-15DOI: 10.1016/j.urolonc.2025.08.015
Jihad Kaouk M.D., Adriana M. Pedraza M.D., Nicolas Soputro M.D., Jaya S. Chavali M.D., Carter Mikesell M.D., Roxana Ramos-Carpinteyro M.D., Jane Nguyen M.D., Alp Tuna Beksac M.D., Zeyad Schwen M.D., Ruben Olivares M.D., Christopher Weight M.D.
Background
The transition from open to robotic radical prostatectomy has enhanced perioperative outcomes while maintaining oncologic safety. There is a growing focus on approaches that expedite the recovery of functional parameters. In line with this, our team introduced the Single-Port Transvesical Robot-Assisted Radical Prostatectomy (SPTVRARP) and aims to present intermediate-term follow-up outcomes.
Methods
We assessed patients who underwent surgery between December 2020 and December 2024 with at least 12 months of follow-up.
Results
Among 248 patients, most had intermediate-risk prostate cancer. The average age was 63 years, with a median PSA of 5.7 ng/ml. Final pathology mainly indicated ISUP GG2 disease, with 45.2% showing non-organ confined cancer. Surgical margins were negative in 79.1% of cases, and the median hospital stay was 5.6 hours. At discharge, 93.2% did not need opioids. Immediate urinary continence was achieved by 45.1%, increasing to 68.5%, 77.0%, 88.3%, and 95.1% at 6 weeks, 3, 6, and 12 months. Of the 196 patients who underwent nerve-sparing surgery, 63.7% were potent at baseline, with a mean SHIM score of 10 at 12 months. Preserving anterior periprostatic structures led to erections sufficient for penetration in 66.6%, 75.0%, and 87.5% at 3, 6, and 12 months. The estimated BCR-free survival rate at 26 months was 94.1%. Limitations include the single-center, single surgeon design, which restricts result generalizability.
Conclusions
SPTVRARP optimizes perioperative outcomes. It shortens hospital stays, reduces opioid use, facilitates early catheter removal, and accelerates urinary continence recovery while ensuring oncologic safety.
{"title":"Exploring the promise of robot-assisted single-port transvesical radical prostatectomy: Insights from intermediate-term follow-up","authors":"Jihad Kaouk M.D., Adriana M. Pedraza M.D., Nicolas Soputro M.D., Jaya S. Chavali M.D., Carter Mikesell M.D., Roxana Ramos-Carpinteyro M.D., Jane Nguyen M.D., Alp Tuna Beksac M.D., Zeyad Schwen M.D., Ruben Olivares M.D., Christopher Weight M.D.","doi":"10.1016/j.urolonc.2025.08.015","DOIUrl":"10.1016/j.urolonc.2025.08.015","url":null,"abstract":"<div><h3>Background</h3><div>The transition from open to robotic radical prostatectomy has enhanced perioperative outcomes while maintaining oncologic safety. There is a growing focus on approaches that expedite the recovery of functional parameters. In line with this, our team introduced the Single-Port Transvesical Robot-Assisted Radical Prostatectomy (SPTVRARP) and aims to present intermediate-term follow-up outcomes.</div></div><div><h3>Methods</h3><div>We assessed patients who underwent surgery between December 2020 and December 2024 with at least 12 months of follow-up.</div></div><div><h3>Results</h3><div>Among 248 patients, most had intermediate-risk prostate cancer. The average age was 63 years, with a median PSA of 5.7 ng/ml. Final pathology mainly indicated ISUP GG2 disease, with 45.2% showing non-organ confined cancer. Surgical margins were negative in 79.1% of cases, and the median hospital stay was 5.6 hours. At discharge, 93.2% did not need opioids. Immediate urinary continence was achieved by 45.1%, increasing to 68.5%, 77.0%, 88.3%, and 95.1% at 6 weeks, 3, 6, and 12 months. Of the 196 patients who underwent nerve-sparing surgery, 63.7% were potent at baseline, with a mean SHIM score of 10 at 12 months. Preserving anterior periprostatic structures led to erections sufficient for penetration in 66.6%, 75.0%, and 87.5% at 3, 6, and 12 months. The estimated BCR-free survival rate at 26 months was 94.1%. Limitations include the single-center, single surgeon design, which restricts result generalizability.</div></div><div><h3>Conclusions</h3><div>SPTVRARP optimizes perioperative outcomes. It shortens hospital stays, reduces opioid use, facilitates early catheter removal, and accelerates urinary continence recovery while ensuring oncologic safety.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 12","pages":"Pages 721.e1-721.e8"},"PeriodicalIF":2.3,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303564","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 : 2025-10-14DOI: 10.1016/j.urolonc.2025.09.009
Yunhe Tian , Yue Sun , Meijing Hu , Yu Jin , Jiao Pei , Xinyi Lei , Cairong Zhu
Background
The current analysis of the global burden of kidney cancer (KC) is limited and outdated. Thus, the risk of KC in the younger generation may have been overlooked. This study assessed KC incidence trends in 37 countries from 1988 to 2037 and compared the specific annual percentage changes between younger and older generations across countries.
Methods
This study analyzed KC incidence trends in 37 countries (1988–2037) through age-period-cohort modeling using Cancer Incidence in Five Continents (CI5) data and calculated age-specific annual percentage changes.
Results
According to the latest data from CI5, there were 388,595 newly diagnosed KC cases, with age-standardized rates (ASRs) of 27.09 per 100,000 individuals. KC incidence exhibited significant geographical disparities, with the largest difference being 36 times. The ASRs of KC increased in 32 of 37 countries, 1988 to 2017. The incidence of KC has increased among young men (<50 years) in 24 countries and among young women in 18 countries. The annual percentage changes in cohort effects were greater in the younger age groups in 16 countries among men and in 9 countries among women. The overall cohort effect increased in 22 countries for men and 21 countries for women. Projections to 2037 suggest that KC rates will increase in 24 countries for men and in 20 countries for women, with some countries experiencing a 32-fold increase.
Conclusion
The global incidence of KC is increasing, particularly among younger birth cohorts. It is essential to advocate weight management a hypertension control, particularly in the younger generation.
{"title":"Kidney cancer incidence trends in 37 countries from 1988 to 2037: Rising rates among young generation","authors":"Yunhe Tian , Yue Sun , Meijing Hu , Yu Jin , Jiao Pei , Xinyi Lei , Cairong Zhu","doi":"10.1016/j.urolonc.2025.09.009","DOIUrl":"10.1016/j.urolonc.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>The current analysis of the global burden of kidney cancer (KC) is limited and outdated. Thus, the risk of KC in the younger generation may have been overlooked. This study assessed KC incidence trends in 37 countries from 1988 to 2037 and compared the specific annual percentage changes between younger and older generations across countries.</div></div><div><h3>Methods</h3><div>This study analyzed KC incidence trends in 37 countries (1988–2037) through age-period-cohort modeling using Cancer Incidence in Five Continents (CI5) data and calculated age-specific annual percentage changes.</div></div><div><h3>Results</h3><div>According to the latest data from CI5, there were 388,595 newly diagnosed KC cases, with age-standardized rates (ASRs) of 27.09 per 100,000 individuals. KC incidence exhibited significant geographical disparities, with the largest difference being 36 times. The ASRs of KC increased in 32 of 37 countries, 1988 to 2017. The incidence of KC has increased among young men (<50 years) in 24 countries and among young women in 18 countries. The annual percentage changes in cohort effects were greater in the younger age groups in 16 countries among men and in 9 countries among women. The overall cohort effect increased in 22 countries for men and 21 countries for women. Projections to 2037 suggest that KC rates will increase in 24 countries for men and in 20 countries for women, with some countries experiencing a 32-fold increase.</div></div><div><h3>Conclusion</h3><div>The global incidence of KC is increasing, particularly among younger birth cohorts. It is essential to advocate weight management a hypertension control, particularly in the younger generation.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 67.e9-67.e18"},"PeriodicalIF":2.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303498","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 : 2025-10-13DOI: 10.1016/j.urolonc.2025.09.017
Daniel J. Lama MD , Salvador Jaime-Casas MD , Ahmad Imam MD , Oluwatimilehin Okunowo MPH , Clayton S. Lau MD , Wesley Yip MD , Bertram E. Yuh MD , Kevin G. Chan MD
Objective
To evaluate the performance of short-term renal ultrasound (RUS) as a surveillance tool to detect ureteroenteric anastomotic strictures (UAS) following robot-assisted radical cystectomy (RARC) and extracorporeal urinary diversion (ECUD).
Methods
Patients with bladder cancer who underwent RARC and ECUD at a single tertiary center between October 2011 and August 2022 were included. All patients underwent a planned RUS at 6-weeks postoperatively. A radiologist and a urologist centrally reviewed all images to identify kidneys with hydronephrosis, which was diagnosed based on renal pelvis or calyceal dilation. Renal units with sonographic evidence of hydronephrosis underwent further confirmatory testing using fluoroscopic imaging (loopogram or pouchogram) and nuclear imaging (renal scan with Lasix washout). UAS was confirmed by placing a nephrostomy tube and an antegrade nephrostogram.
Results
From a cohort of 392 patients who underwent RARC and ECUD, 316 were included. The median follow-up time was 36.8 months (IQR: 19.5, 78.8). A total of 623 renal units underwent 6-week RUS. Sonographic evidence of hydronephrosis was found in 23% (n = 143) of the units, of which 17% (n = 25) developed UAS. Of the 480 renal units without hydronephrosis, 0.2% (n = 1) developed UAS. 6-week RUS showed 96% and 80% sensitivity and specificity, respectively. The positive and negative predictive values were 17% and 99%, respectively.
Conclusions
A negative 6-week postoperative RUS can strongly predict the absence of UAS, making it a reliable, cost-effective, and non-invasive first-line screening modality to identify patients at a low risk of developing UAS after RARC and ECUD.
{"title":"Renal ultrasound as a surveillance method for ureteroenteric anastomotic stricture following radical cystectomy and urinary diversion","authors":"Daniel J. Lama MD , Salvador Jaime-Casas MD , Ahmad Imam MD , Oluwatimilehin Okunowo MPH , Clayton S. Lau MD , Wesley Yip MD , Bertram E. Yuh MD , Kevin G. Chan MD","doi":"10.1016/j.urolonc.2025.09.017","DOIUrl":"10.1016/j.urolonc.2025.09.017","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the performance of short-term renal ultrasound (RUS) as a surveillance tool to detect ureteroenteric anastomotic strictures (UAS) following robot-assisted radical cystectomy (RARC) and extracorporeal urinary diversion (ECUD).</div></div><div><h3>Methods</h3><div>Patients with bladder cancer who underwent RARC and ECUD at a single tertiary center between October 2011 and August 2022 were included. All patients underwent a planned RUS at 6-weeks postoperatively. A radiologist and a urologist centrally reviewed all images to identify kidneys with hydronephrosis, which was diagnosed based on renal pelvis or calyceal dilation. Renal units with sonographic evidence of hydronephrosis underwent further confirmatory testing using fluoroscopic imaging (loopogram or pouchogram) and nuclear imaging (renal scan with Lasix washout). UAS was confirmed by placing a nephrostomy tube and an antegrade nephrostogram.</div></div><div><h3>Results</h3><div>From a cohort of 392 patients who underwent RARC and ECUD, 316 were included. The median follow-up time was 36.8 months (IQR: 19.5, 78.8). A total of 623 renal units underwent 6-week RUS. Sonographic evidence of hydronephrosis was found in 23% (<em>n</em> = 143) of the units, of which 17% (<em>n</em> = 25) developed UAS. Of the 480 renal units without hydronephrosis, 0.2% (<em>n</em> = 1) developed UAS. 6-week RUS showed 96% and 80% sensitivity and specificity, respectively. The positive and negative predictive values were 17% and 99%, respectively.</div></div><div><h3>Conclusions</h3><div>A negative 6-week postoperative RUS can strongly predict the absence of UAS, making it a reliable, cost-effective, and non-invasive first-line screening modality to identify patients at a low risk of developing UAS after RARC and ECUD.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 64.e1-64.e6"},"PeriodicalIF":2.3,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293846","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 : 2025-10-10DOI: 10.1016/j.urolonc.2025.10.002
Betty H. Wang
{"title":"Featured SUO Fellow: Betty H. Wang, MD","authors":"Betty H. Wang","doi":"10.1016/j.urolonc.2025.10.002","DOIUrl":"10.1016/j.urolonc.2025.10.002","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 12","pages":"Page 699"},"PeriodicalIF":2.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275942","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 : 2025-10-10DOI: 10.1016/j.urolonc.2025.08.030
Andrew Gusev M.D. , Florian Rumpf M.D. , Dimitar Zlatev M.D., M.S. , Jeffrey K. Twum-Ampofo M.D. , John L. Gore M.D., M.S. , Douglas M. Dahl M.D. , Matthew F. Wszolek M.D. , Jason Efstathiou M.D., D.Phil. , Richard J. Lee M.D., Ph.D. , Michael L. Blute M.D. , Keyan Salari M.D., Ph.D. , Adam S. Feldman M.D., M.P.H.
Purpose
The safety and efficacy of active surveillance (AS) for men with prostate cancer (PCa) depend on accurate risk stratification at diagnosis and during follow-up. Initial PSA density (PSAD) has been associated with the risk of AS progression when measured at diagnosis, yet few studies have examined the impact of changes in PSAD during follow-up. We investigated whether serial PSAD measurements during AS were prognostic of subsequent biopsy grade progression.
Patients and Methods
We queried our institutional AS database to identify men with Grade Group 1 PCa, ≥ 2 prostate biopsies, and ≥ 2 PSAD measurements at least 1 year apart. The median follow-up time was 5.9 years. The primary outcome was grade progression on subsequent AS biopsy. The utility of trending PSAD during AS was evaluated using 2 models: PSAD change over time (PSAD velocity) in a cross-validated logistic regression and serial PSAD measurements in a Cox proportional hazards model with time-varying covariates.
Results
A total of 453 patients were included, of whom 137 met the primary outcome of biopsy pathological grade progression. Among the rich multivariate model, serial PSAD measurements had the highest concordance index (0.75) as a prognostic marker of biopsy progression. Patients with a net positive PSAD velocity (increasing PSAD over AS) had an OR of 1.97 (95% CI 1.26–3.11) and those with a PSAD value ≥0.15 ng/ml2 at any point during AS had a HR of 3.70 (95% CI 2.45–5.60).
Conclusions
Our data suggest that serial PSAD measurements and PSAD velocity are strong independent prognostic markers of biopsy grade progression in AS. As prostate volume and PSA measurements are already part of AS protocols, monitoring PSAD trends over time confers no additional cost and should be integrated into clinical practice to improve risk stratification.
目的：主动监测（AS）对前列腺癌（PCa）患者的安全性和有效性取决于诊断时和随访期间准确的风险分层。在诊断时测量的初始PSA密度（PSAD）与AS进展的风险相关，但很少有研究检查PSAD在随访期间变化的影响。我们研究了AS期间的连续PSAD测量是否能预测随后的活检分级进展。患者和方法：我们查询了我们的机构AS数据库，以识别1级组PCa，≥2次前列腺活检和≥2次PSAD测量间隔至少1年的男性。中位随访时间为5.9年。主要结局是随后AS活检的分级进展。采用两种模型评估AS期间PSAD趋势的效用：交叉验证逻辑回归中的PSAD随时间变化（PSAD速度）和随时间变化协变量的Cox比例风险模型中的连续PSAD测量。结果：共纳入453例患者，其中137例符合活检病理级进展的主要结局。在丰富的多变量模型中，连续PSAD测量作为活检进展的预后标志物具有最高的一致性指数（0.75）。PSAD净阳性速度（PSAD高于AS）的患者的OR为1.97 (95% CI 1.26-3.11)，而在AS期间任何时刻PSAD值≥0.15 ng/ml2的患者的HR为3.70 （95% CI 2.45-5.60）。结论：我们的数据表明，连续PSAD测量和PSAD速度是AS活检级进展的强有力的独立预后标志物。由于前列腺体积和PSA测量已经是As方案的一部分，随着时间的推移监测PSAD趋势不会带来额外的成本，应该整合到临床实践中，以改善风险分层。
{"title":"PSA density as a dynamic prognostic marker of biopsy grade progression during active surveillance","authors":"Andrew Gusev M.D. , Florian Rumpf M.D. , Dimitar Zlatev M.D., M.S. , Jeffrey K. Twum-Ampofo M.D. , John L. Gore M.D., M.S. , Douglas M. Dahl M.D. , Matthew F. Wszolek M.D. , Jason Efstathiou M.D., D.Phil. , Richard J. Lee M.D., Ph.D. , Michael L. Blute M.D. , Keyan Salari M.D., Ph.D. , Adam S. Feldman M.D., M.P.H.","doi":"10.1016/j.urolonc.2025.08.030","DOIUrl":"10.1016/j.urolonc.2025.08.030","url":null,"abstract":"<div><h3>Purpose</h3><div>The safety and efficacy of active surveillance (AS) for men with prostate cancer (PCa) depend on accurate risk stratification at diagnosis and during follow-up. Initial PSA density (PSAD) has been associated with the risk of AS progression when measured at diagnosis, yet few studies have examined the impact of changes in PSAD during follow-up. We investigated whether serial PSAD measurements during AS were prognostic of subsequent biopsy grade progression.</div></div><div><h3>Patients and Methods</h3><div>We queried our institutional AS database to identify men with Grade Group 1 PCa, ≥ 2 prostate biopsies, and ≥ 2 PSAD measurements at least 1 year apart. The median follow-up time was 5.9 years. The primary outcome was grade progression on subsequent AS biopsy. The utility of trending PSAD during AS was evaluated using 2 models: PSAD change over time (PSAD velocity) in a cross-validated logistic regression and serial PSAD measurements in a Cox proportional hazards model with time-varying covariates.</div></div><div><h3>Results</h3><div>A total of 453 patients were included, of whom 137 met the primary outcome of biopsy pathological grade progression. Among the rich multivariate model, serial PSAD measurements had the highest concordance index (0.75) as a prognostic marker of biopsy progression. Patients with a net positive PSAD velocity (increasing PSAD over AS) had an OR of 1.97 (95% CI 1.26–3.11) and those with a PSAD value ≥0.15 ng/ml<sup>2</sup> at any point during AS had a HR of 3.70 (95% CI 2.45–5.60).</div></div><div><h3>Conclusions</h3><div>Our data suggest that serial PSAD measurements and PSAD velocity are strong independent prognostic markers of biopsy grade progression in AS. As prostate volume and PSA measurements are already part of AS protocols, monitoring PSAD trends over time confers no additional cost and should be integrated into clinical practice to improve risk stratification.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 12","pages":"Pages 709.e9-709.e17"},"PeriodicalIF":2.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275957","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 : 2025-10-09DOI: 10.1016/j.urolonc.2025.09.008
Vanessa N. Peña M.D. , Shan Wu M.S. , Oluwaseun Orikogbo M.D. , Peyton A. Skupin M.D. , Mitchell Alameddine M.D. , Jonathan G. Yabes Ph.D. , Daniel Beichner B.S. , Adam C. Olson M.D. , Benjamin J. Davies M.D. , Lindsay M. Sabik PhD , Bruce L. Jacobs M.D., M.P.H.
Introduction and objective
Stereotactic body radiation therapy (SBRT) is a novel form of radiotherapy for prostate cancer which uses ultra-hypofractionated radiation and allows for fewer treatment sessions compared to moderately hypofractionated regimens including intensity-modulated radiation therapy (IMRT). Recent studies have demonstrated comparable oncologic outcomes between SBRT and IMRT for intermediate-risk prostate cancer. We sought to compare the cost of SBRT and IMRT for intermediate-risk prostate cancer.
Methods
We identified men over age 66 diagnosed with intermediate-risk prostate cancer who underwent IMRT or SBRT from 2008 to 2017 using the Surveillance, Epidemiology and End Results—Medicare Linked Database to compare per patient radiation-specific costs. Patients who received a therapeutic regimen, defined as ≥20 fractions of IMRT and ≥2 fractions of SBRT within 90 days, were included. Additionally, only patients treated in 1 locality was included to account for geographic variability in healthcare costs. Linear mixed-effects regression was used to compare per patient costs.
Results
The final cohort included 934 IMRT patients and 237 SBRT patients. Our adjusted model showed the estimated total cost per patient was $20,130 for IMRT and $9,259 for SBRT (P < 0.01). Predictors of higher cost included residing in high-density areas, higher education levels, higher median household income, and earlier years of radiation treatment.
Conclusion
SBRT has significantly lower radiation-specific costs compared to IMRT for intermediate-risk prostate cancer. Our findings support the adoption of SBRT for the treatment of localized prostate cancer to lower healthcare costs while maintaining quality prostate cancer care.
{"title":"An opportunity to save? SBRT is less costly than IMRT for intermediate-risk prostate cancer","authors":"Vanessa N. Peña M.D. , Shan Wu M.S. , Oluwaseun Orikogbo M.D. , Peyton A. Skupin M.D. , Mitchell Alameddine M.D. , Jonathan G. Yabes Ph.D. , Daniel Beichner B.S. , Adam C. Olson M.D. , Benjamin J. Davies M.D. , Lindsay M. Sabik PhD , Bruce L. Jacobs M.D., M.P.H.","doi":"10.1016/j.urolonc.2025.09.008","DOIUrl":"10.1016/j.urolonc.2025.09.008","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>Stereotactic body radiation therapy (SBRT) is a novel form of radiotherapy for prostate cancer which uses ultra-hypofractionated radiation and allows for fewer treatment sessions compared to moderately hypofractionated regimens including intensity-modulated radiation therapy (IMRT). Recent studies have demonstrated comparable oncologic outcomes between SBRT and IMRT for intermediate-risk prostate cancer. We sought to compare the cost of SBRT and IMRT for intermediate-risk prostate cancer.</div></div><div><h3>Methods</h3><div>We identified men over age 66 diagnosed with intermediate-risk prostate cancer who underwent IMRT or SBRT from 2008 to 2017 using the Surveillance, Epidemiology and End Results—Medicare Linked Database to compare per patient radiation-specific costs. Patients who received a therapeutic regimen, defined as ≥20 fractions of IMRT and ≥2 fractions of SBRT within 90 days, were included. Additionally, only patients treated in 1 locality was included to account for geographic variability in healthcare costs. Linear mixed-effects regression was used to compare per patient costs.</div></div><div><h3>Results</h3><div>The final cohort included 934 IMRT patients and 237 SBRT patients. Our adjusted model showed the estimated total cost per patient was $20,130 for IMRT and $9,259 for SBRT (<em>P</em> < 0.01). Predictors of higher cost included residing in high-density areas, higher education levels, higher median household income, and earlier years of radiation treatment.</div></div><div><h3>Conclusion</h3><div>SBRT has significantly lower radiation-specific costs compared to IMRT for intermediate-risk prostate cancer. Our findings support the adoption of SBRT for the treatment of localized prostate cancer to lower healthcare costs while maintaining quality prostate cancer care.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 12","pages":"Pages 721.e9-721.e16"},"PeriodicalIF":2.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259244","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 : 2025-10-08DOI: 10.1016/j.urolonc.2025.09.003
Betty Wang M.D. , Devika Nandwana M.D. , Laura E. Davis M.D. , Sahab Ram Dewala Ph.D. , Can Aydogdu M.D. , Christopher J. Weight M.D. , Samuel Haywood M.D. , Mohamed Eltemamy M.D. , Rebecca Campbell M.D. , Mohit Sindhani MBA , Robert Abouassaly M.D. , Reza Alaghehbandan M.D. , Laura Bukavina M.D.
Introduction and Objectives
Primary urethral cancer (PUC) is a rare malignancy (<1% of all urological cancers). High-grade or advanced cases often require multimodal treatment, including surgery, chemotherapy, immunotherapy, and radiotherapy. This study reviews outcomes and predictors of recurrence and survival in PUC at our tertiary care center.
Methods
We conducted a retrospective chart review at a single tertiary care institution, identifying 251 urethral cancer cases from January 1, 2014, to July 1, 2024. After excluding 163 cases due to non-PUC or insufficient follow-up, 88 cases remained. We collected data on demographics, tumor pathology, treatment modality, and oncologic outcomes. Primary outcomes included overall survival (OS) and recurrence-free survival (RFS). Cox regression was used to assess predictors of OS and RFS.
Results
The cohort included 53 men (60%), with a median age of 64 years. Squamous cell carcinoma was most common (51%), followed by urothelial carcinoma (20%), adenocarcinoma (20%), and variant histology (8%). At presentation, 45% had locally advanced disease (T3/T4), 23% had nodal involvement, and 12% were metastatic. Treatment included surgery (82%), systemic therapy (40%), radiation (36%), and multimodal therapy (41%). Multivariable analysis showed that nonurothelial histology (HR = 8.09, P = 0.04) was associated with increased risk of recurrence, while nodal involvement (HR = 5.63, P < 0.01) predicted worse OS.
Conclusion
In this large North American cohort, nodal involvement predicted worse survival, while nonurothelial histology was linked to shorter recurrence-free survival. These findings support multidisciplinary care and highlight the need for prospective registries in this rare malignancy.
前言和目的：原发性尿道癌（PUC）是一种罕见的恶性肿瘤。方法：回顾性分析2014年1月1日至2024年7月1日在一家三级医疗机构的251例尿道癌病例。在排除163例非puc或随访不足的病例后，仍有88例。我们收集了人口统计学、肿瘤病理、治疗方式和肿瘤预后的数据。主要结局包括总生存期（OS）和无复发生存期（RFS）。采用Cox回归评估OS和RFS的预测因素。结果：该队列包括53名男性（60%），中位年龄64岁。鳞状细胞癌最常见（51%），其次是尿路上皮癌（20%）、腺癌（20%）和组织学变异（8%）。在就诊时，45%为局部晚期疾病（T3/T4）， 23%有淋巴结累及，12%有转移。治疗包括手术（82%）、全身治疗（40%）、放射治疗（36%）和多模式治疗（41%）。多变量分析显示，非尿路上皮组织（HR = 8.09, P = 0.04）与复发风险增加相关，而淋巴结累及（HR = 5.63, P < 0.01）预示较差的OS。结论：在这个大型的北美队列中，淋巴结受累预示着更差的生存，而非尿路上皮组织与更短的无复发生存有关。这些发现支持多学科治疗，并强调对这种罕见恶性肿瘤进行前瞻性登记的必要性。
{"title":"Clinical and histological predictors of treatment outcomes in primary urethral carcinoma","authors":"Betty Wang M.D. , Devika Nandwana M.D. , Laura E. Davis M.D. , Sahab Ram Dewala Ph.D. , Can Aydogdu M.D. , Christopher J. Weight M.D. , Samuel Haywood M.D. , Mohamed Eltemamy M.D. , Rebecca Campbell M.D. , Mohit Sindhani MBA , Robert Abouassaly M.D. , Reza Alaghehbandan M.D. , Laura Bukavina M.D.","doi":"10.1016/j.urolonc.2025.09.003","DOIUrl":"10.1016/j.urolonc.2025.09.003","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Primary urethral cancer (PUC) is a rare malignancy (<1% of all urological cancers). High-grade or advanced cases often require multimodal treatment, including surgery, chemotherapy, immunotherapy, and radiotherapy. This study reviews outcomes and predictors of recurrence and survival in PUC at our tertiary care center.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review at a single tertiary care institution, identifying 251 urethral cancer cases from January 1, 2014, to July 1, 2024. After excluding 163 cases due to non-PUC or insufficient follow-up, 88 cases remained. We collected data on demographics, tumor pathology, treatment modality, and oncologic outcomes. Primary outcomes included overall survival (OS) and recurrence-free survival (RFS). Cox regression was used to assess predictors of OS and RFS.</div></div><div><h3>Results</h3><div>The cohort included 53 men (60%), with a median age of 64 years. Squamous cell carcinoma was most common (51%), followed by urothelial carcinoma (20%), adenocarcinoma (20%), and variant histology (8%). At presentation, 45% had locally advanced disease (T3/T4), 23% had nodal involvement, and 12% were metastatic. Treatment included surgery (82%), systemic therapy (40%), radiation (36%), and multimodal therapy (41%). Multivariable analysis showed that nonurothelial histology (HR = 8.09, <em>P</em> = 0.04) was associated with increased risk of recurrence, while nodal involvement (HR = 5.63, <em>P</em> < 0.01) predicted worse OS.</div></div><div><h3>Conclusion</h3><div>In this large North American cohort, nodal involvement predicted worse survival, while nonurothelial histology was linked to shorter recurrence-free survival. These findings support multidisciplinary care and highlight the need for prospective registries in this rare malignancy.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 12","pages":"Pages 700-705"},"PeriodicalIF":2.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252880","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 : 2025-10-08DOI: 10.1016/j.urolonc.2025.09.011
Ben Frederik Hartwieg , Tobias Maurer , Christopher Kniep , Philipp Mandel , Mike Wenzel , Fabian Falkenbach , Lars Budäus , Thomas Steuber , Markus Graefen , Derya Tilki , Felix Preisser
Objective
Current EAU guidelines provide only a weak recommendation for staging (computed tomography [CT], magnetic resonance imaging [MRI], bone scan, or prostate-specific membrane antigen [PSMA] positron emission tomography [PET]/CT) in selected intermediate-risk prostate cancer (irPCa) patients. However, data on the real-world application of staging in this group are limited. We aimed to assess the use of various imaging modalities for distant staging in irPCa patients scheduled for radical prostatectomy (RP).
Material and methods
We identified irPCa patients from a high-volume institutional database who underwent primary RP between 2015 and 2021. The use of different staging modalities was assessed, with stratification according to NCCN criteria into favorable and unfavorable intermediate-risk groups. Annual trends were analyzed.
Results
Among 9,512 irPCa patients, 37.4% had favorable and 62.6% unfavorable disease. Overall, 42.0% underwent any form of staging prior to RP, with higher rates in unfavorable versus favorable disease (48.5% vs. 31%, P < 0.001). The detection rates of locoregional or metastatic disease using conventional imaging were low (0%–2.0%). For PSMA PET/CT, the rates were 5.0% and 4.3% in the favorable and unfavorable groups, respectively. Bone scans (34.7%) and abdominopelvic CT (28.0%) were most frequently used in unfavorable cases, with 20.1% undergoing both. Only 6.2% (n = 369) of unfavorable patients received PSMA PET/CT. Among favorable cases, 22.0% underwent bone scans and 17.8% abdominopelvic CT; 11.9% had both, and just 2.8% (n = 100) received PSMA PET/CT. MRI was rarely used (1.7%; 1.9% in unfavorable vs. 1.3% in favorable cases, P = 0.1). Overall staging rates remained stable during the study period (EAPC: 0.04, P = 0.9), whereas PSMA PET/CT usage significantly increased in the total cohort (EAPC: 17.9, P < 0.01) and in the unfavorable group (EAPC: 21.1, P < 0.01).
Conclusions
Less than half of patients with unfavorable irPCa and approximately one-third of those with favorable irPCa underwent distant staging. Positive findings were rare, especially with conventional imaging. Therefore, conventional staging might be safely omitted in irPCa, while PSMA PET/CT may be considered in selected patients when staging is deemed necessary, as it provides more accurate information.
目的：目前的EAU指南仅对选定的中危前列腺癌（irPCa）患者的分期（计算机断层扫描[CT]、磁共振成像[MRI]、骨扫描或前列腺特异性膜抗原[PSMA]正电子发射断层扫描[PET]/CT）提供了弱推荐。然而，关于分期在这一群体中的实际应用的数据是有限的。我们的目的是评估各种成像方式对计划进行根治性前列腺切除术（RP）的irPCa患者的远程分期的使用。材料和方法：我们从一个大容量的机构数据库中确定了2015年至2021年间接受原发性RP的irPCa患者。评估了不同分期方式的使用情况，并根据NCCN标准分为有利和不利的中危组。分析了年度趋势。结果：9512例irPCa患者中，37.4%为有利病变，62.6%为不利病变。总体而言，42.0%的患者在RP之前经历了任何形式的分期，不利疾病的比例高于有利疾病的比例（48.5%对31%，P < 0.001）。常规影像学对局部或转移性疾病的检出率较低（0%-2.0%）。对于PSMA PET/CT，有利组和不利组的发生率分别为5.0%和4.3%。骨扫描（34.7%）和腹部骨盆CT（28.0%）在不良病例中最常使用，20.1%同时使用。只有6.2% （n = 369）的不良患者接受了PSMA PET/CT检查。在有利病例中，22.0%接受骨扫描，17.8%接受腹部骨盆CT；11.9%的患者两者都有，只有2.8% （n = 100）接受了PSMA PET/CT。MRI很少使用（1.7%，不良病例为1.9%，良好病例为1.3%,P = 0.1）。总体分期率在研究期间保持稳定（EAPC: 0.04, P = 0.9），而PSMA PET/CT使用率在整个队列（EAPC: 17.9, P < 0.01）和不良组（EAPC: 21.1, P < 0.01）中显著增加。结论：不到一半的不良irPCa患者和大约三分之一的良好irPCa患者进行了远期分期。阳性结果罕见，尤其是常规影像学检查。因此，在irPCa中可以安全地忽略传统的分期，而PSMA PET/CT可以在认为需要分期的特定患者中考虑，因为它提供了更准确的信息。
{"title":"Use of staging in intermediate-risk prostate cancer: A real-world data analysis","authors":"Ben Frederik Hartwieg , Tobias Maurer , Christopher Kniep , Philipp Mandel , Mike Wenzel , Fabian Falkenbach , Lars Budäus , Thomas Steuber , Markus Graefen , Derya Tilki , Felix Preisser","doi":"10.1016/j.urolonc.2025.09.011","DOIUrl":"10.1016/j.urolonc.2025.09.011","url":null,"abstract":"<div><h3>Objective</h3><div>Current EAU guidelines provide only a weak recommendation for staging (computed tomography [CT], magnetic resonance imaging [MRI], bone scan, or prostate-specific membrane antigen [PSMA] positron emission tomography [PET]/CT) in selected intermediate-risk prostate cancer (irPCa) patients. However, data on the real-world application of staging in this group are limited. We aimed to assess the use of various imaging modalities for distant staging in irPCa patients scheduled for radical prostatectomy (RP).</div></div><div><h3>Material and methods</h3><div>We identified irPCa patients from a high-volume institutional database who underwent primary RP between 2015 and 2021. The use of different staging modalities was assessed, with stratification according to NCCN criteria into favorable and unfavorable intermediate-risk groups. Annual trends were analyzed.</div></div><div><h3>Results</h3><div>Among 9,512 irPCa patients, 37.4% had favorable and 62.6% unfavorable disease. Overall, 42.0% underwent any form of staging prior to RP, with higher rates in unfavorable versus favorable disease (48.5% vs. 31%, <em>P</em> < 0.001). The detection rates of locoregional or metastatic disease using conventional imaging were low (0%–2.0%). For PSMA PET/CT, the rates were 5.0% and 4.3% in the favorable and unfavorable groups, respectively. Bone scans (34.7%) and abdominopelvic CT (28.0%) were most frequently used in unfavorable cases, with 20.1% undergoing both. Only 6.2% (<em>n</em> = 369) of unfavorable patients received PSMA PET/CT. Among favorable cases, 22.0% underwent bone scans and 17.8% abdominopelvic CT; 11.9% had both, and just 2.8% (<em>n</em> = 100) received PSMA PET/CT. MRI was rarely used (1.7%; 1.9% in unfavorable vs. 1.3% in favorable cases, <em>P</em> = 0.1). Overall staging rates remained stable during the study period (EAPC: 0.04, <em>P</em> = 0.9), whereas PSMA PET/CT usage significantly increased in the total cohort (EAPC: 17.9, <em>P</em> < 0.01) and in the unfavorable group (EAPC: 21.1, <em>P</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>Less than half of patients with unfavorable irPCa and approximately one-third of those with favorable irPCa underwent distant staging. Positive findings were rare, especially with conventional imaging. Therefore, conventional staging might be safely omitted in irPCa, while PSMA PET/CT may be considered in selected patients when staging is deemed necessary, as it provides more accurate information.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 71.e1-71.e7"},"PeriodicalIF":2.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259216","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 : 2025-10-08DOI: 10.1016/j.urolonc.2025.10.001
Mário Fontes-Sousa M.D. , Helena Magalhães M.D. , Fernando Calais da Silva M.D. , Maria Joaquina Maurício M.D.
{"title":"Corrigendum to ‘Stauffer's syndrome: A comprehensive review and proposed updated diagnostic criteria’ [Urologic Oncology: Seminars and Original Investigations Volume 36, Issue 7 (2018) 321-326]","authors":"Mário Fontes-Sousa M.D. , Helena Magalhães M.D. , Fernando Calais da Silva M.D. , Maria Joaquina Maurício M.D.","doi":"10.1016/j.urolonc.2025.10.001","DOIUrl":"10.1016/j.urolonc.2025.10.001","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 12","pages":"Page 723"},"PeriodicalIF":2.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259189","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}
Recent clinical trials have highlighted the benefits of adjuvant therapies for upper tract urothelial carcinoma (UTUC), although their application remains limited by patient-specific factors. This study aimed to develop a prognostic model to predict postoperative outcomes and identify patients who would benefit from adjuvant therapy.
Methods
We conducted a retrospective analysis of 700 UTUC patients who underwent radical nephroureterectomy at Jikei University Hospital and its affiliated institutions (development cohort), and 405 patients treated at Mayo Clinic (validation cohort). Patients who received neoadjuvant or adjuvant chemotherapy were excluded. In the development cohort, clinical and pathological variables were analyzed to construct a risk prediction model for postoperative recurrence. Statistical analyses included Kaplan-Meier estimation, Cox proportional hazards regression, and internal validation using bootstrapping. The model was externally validated using data from the validation cohort.
Results
The final model incorporated pT stage, pN stage, tumor grade, and lymphovascular invasion, resulting in the novel "JIKEI-YAYOI" risk score (range: 0–7). The model demonstrated excellent discrimination (C-index: 0.815) and calibration. Patients were stratified into low, intermediate, and high-risk groups, each with distinct recurrence-free survival rates. The JIKEI-YAYOI score provided accurate, individualized risk predictions, facilitating clinical decision-making regarding adjuvant therapy.
Conclusion
The JIKEI-YAYOI score reliably predicts disease recurrence following radical surgery for UTUC, supporting personalized patient management and informed decisions about adjuvant therapy.
{"title":"Predicting recurrence after radical nephroureterectomy for upper tract urothelial carcinoma: Development and validation of the JIKEI-YAYOI score","authors":"Yuya Iwamoto M.D. , Halle Foss M.D. , Yudai Ishiyama M.D., Ph.D. , Yuki Taneda M.D. , Hirokazu Kagawa M.D. , Naoki Uchida M.D. , Yuhei Koike M.D. , Shuhei Hara M.D. , Keiichiro Miyajima M.D., Ph.D. , Kosuke Iwatani M.D. , Yu Imai M.D., Ph.D. , Kojiro Tashiro M.D., Ph.D. , Shunsuke Tsuzuki M.D., Ph.D. , Jun Miki M.D., Ph.D. , Sounak Gupta M.D. , Stephen A. Boorjian M.D. , Aaron Potretzke M.D. , Fumihiko Urabe M.D., Ph.D. , Takahiro Kimura M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.09.006","DOIUrl":"10.1016/j.urolonc.2025.09.006","url":null,"abstract":"<div><h3>Background</h3><div>Recent clinical trials have highlighted the benefits of adjuvant therapies for upper tract urothelial carcinoma (UTUC), although their application remains limited by patient-specific factors. This study aimed to develop a prognostic model to predict postoperative outcomes and identify patients who would benefit from adjuvant therapy.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 700 UTUC patients who underwent radical nephroureterectomy at Jikei University Hospital and its affiliated institutions (development cohort), and 405 patients treated at Mayo Clinic (validation cohort). Patients who received neoadjuvant or adjuvant chemotherapy were excluded. In the development cohort, clinical and pathological variables were analyzed to construct a risk prediction model for postoperative recurrence. Statistical analyses included Kaplan-Meier estimation, Cox proportional hazards regression, and internal validation using bootstrapping. The model was externally validated using data from the validation cohort.</div></div><div><h3>Results</h3><div>The final model incorporated pT stage, pN stage, tumor grade, and lymphovascular invasion, resulting in the novel \"JIKEI-YAYOI\" risk score (range: 0–7). The model demonstrated excellent discrimination (C-index: 0.815) and calibration. Patients were stratified into low, intermediate, and high-risk groups, each with distinct recurrence-free survival rates. The JIKEI-YAYOI score provided accurate, individualized risk predictions, facilitating clinical decision-making regarding adjuvant therapy.</div></div><div><h3>Conclusion</h3><div>The JIKEI-YAYOI score reliably predicts disease recurrence following radical surgery for UTUC, supporting personalized patient management and informed decisions about adjuvant therapy.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 12","pages":"Pages 698.e1-698.e8"},"PeriodicalIF":2.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252816","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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