Pub Date : 2026-02-01Epub Date: 2025-11-08DOI: 10.1016/j.urolonc.2025.10.012
Rocío Martínez-Corral , Daniel Pérez-Fentes , Celia Bardella-Altarriba , Francisco Javier Vera-Ballesteros , Arnau Abella-Serra , Sergio Antón Fuente , María Elena Martínez-Corral , Natalia Picola-Brau , Alicia López-Abad , Álvaro Gómez-Ferrer , Manuel Beamud-Cortés , Jose Francisco Suárez-Novo , Pedro Angel López-González , Mireia García-Puche , Ana María Álvarez-Gracia , Pedro De Pablos-Rodríguez
Background
The combination of androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) has transformed the treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC), becoming one of the most widely used standard treatment options. The depth of PSA declines following initiation of ADT plus ARPI—typically defined as a PSA ≤0.2 ng/ml—has shown promise as a reliable prognostic marker for risk stratification in mHSPC patients. This study aimed to identify the most informative time point for PSA response to predict disease progression.
Methods
Retrospective multicenter study of mHSPC patients treated with ADT+ARPI between June 2017 and October 2024, registered in a real-world clinical database. Patients receiving ADT monotherapy, triplet therapy or initiating ARPI more than 6 months after starting ADT were excluded. The primary objective was to assess the predictive value of PSA response at 3, 6, and 9 months for disease progression within 18 months of treatment initiation. Predictive performance was evaluated using discriminant analysis. Groups were defined based on time cut-offs. Patients were classified as biochemical complete response (BCR, PSA ≤0.2 ng/ml) or nonresponse (PSA >0.2 ng/ml) at each time point. Secondary objectives included comparing progression-free survival (PFS) between BCR and NR groups at 6 and 9 months and identifying clinical predictors of progression.
Results
A total of 599 mHSPC patients were included, with a median follow-up of 24 months. Median age at diagnosis was 72 years, and median baseline PSA was 20 ng/ml. BCR rates at 3, 6, and 9 months were 48%, 60%, and 53%, respectively. PSA response demonstrated strong predictive accuracy for progression at 18 months, with the 9-month cutoff showing the highest discriminative ability (AUC = 0.87). The negative predictive value (NPV) was high across all time points (0.92, 0.95, and 0.97), while the positive predictive value (PPV) remained limited (0.44, 0.38, and 0.38). Kaplan–Meier analysis showed significantly longer PFS in BCR versus NR groups at both 6 and 9 months (p < 0.0001). Multivariable analysis identified NR status and high-volume disease as independent predictors of progression.
Conclusion
PSA response at 9 months was the most accurate time point for identifying patients unlikely to experience progression at 18 months. Its high negative predictive value (NPV) supports its potential role in risk stratification, while the limited positive predictive value highlights the need for additional markers to better guide treatment decisions
{"title":"PSA response to predict progression in metastatic hormone-sensitive prostate cancer (mHSPC) patients. When is the optimal time point?","authors":"Rocío Martínez-Corral , Daniel Pérez-Fentes , Celia Bardella-Altarriba , Francisco Javier Vera-Ballesteros , Arnau Abella-Serra , Sergio Antón Fuente , María Elena Martínez-Corral , Natalia Picola-Brau , Alicia López-Abad , Álvaro Gómez-Ferrer , Manuel Beamud-Cortés , Jose Francisco Suárez-Novo , Pedro Angel López-González , Mireia García-Puche , Ana María Álvarez-Gracia , Pedro De Pablos-Rodríguez","doi":"10.1016/j.urolonc.2025.10.012","DOIUrl":"10.1016/j.urolonc.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>The combination of androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) has transformed the treatment landscape of metastatic hormone-sensitive prostate cancer (mHSPC), becoming one of the most widely used standard treatment options. The depth of PSA declines following initiation of ADT plus ARPI—typically defined as a PSA ≤0.2 ng/ml—has shown promise as a reliable prognostic marker for risk stratification in mHSPC patients. This study aimed to identify the most informative time point for PSA response to predict disease progression.</div></div><div><h3>Methods</h3><div>Retrospective multicenter study of mHSPC patients treated with ADT+ARPI between June 2017 and October 2024, registered in a real-world clinical database. Patients receiving ADT monotherapy, triplet therapy or initiating ARPI more than 6 months after starting ADT were excluded. The primary objective was to assess the predictive value of PSA response at 3, 6, and 9 months for disease progression within 18 months of treatment initiation. Predictive performance was evaluated using discriminant analysis. Groups were defined based on time cut-offs. Patients were classified as biochemical complete response (BCR, PSA ≤0.2 ng/ml) or nonresponse (PSA >0.2 ng/ml) at each time point. Secondary objectives included comparing progression-free survival (PFS) between BCR and NR groups at 6 and 9 months and identifying clinical predictors of progression.</div></div><div><h3>Results</h3><div>A total of 599 mHSPC patients were included, with a median follow-up of 24 months. Median age at diagnosis was 72 years, and median baseline PSA was 20 ng/ml. BCR rates at 3, 6, and 9 months were 48%, 60%, and 53%, respectively. PSA response demonstrated strong predictive accuracy for progression at 18 months, with the 9-month cutoff showing the highest discriminative ability (AUC = 0.87). The negative predictive value (NPV) was high across all time points (0.92, 0.95, and 0.97), while the positive predictive value (PPV) remained limited (0.44, 0.38, and 0.38). Kaplan–Meier analysis showed significantly longer PFS in BCR versus NR groups at both 6 and 9 months (<em>p</em> < 0.0001). Multivariable analysis identified NR status and high-volume disease as independent predictors of progression.</div></div><div><h3>Conclusion</h3><div>PSA response at 9 months was the most accurate time point for identifying patients unlikely to experience progression at 18 months. Its high negative predictive value (NPV) supports its potential role in risk stratification, while the limited positive predictive value highlights the need for additional markers to better guide treatment decisions</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 124.e9-124.e15"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477023","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 : 2026-02-01Epub Date: 2025-12-09DOI: 10.1016/j.urolonc.2025.11.005
Jenny Chia-Chen Chang , Agustin Perez-Londoño , Sumedh Kaul , Jamil Almohtasib , Aaron Fleishman , Ruslan Korets , Peter Chang , Andrew Wagner , Joaquim Bellmunt , Aria F. Olumi , Boris Gershman
Background and objective
Accurate prediction of recurrence and progression risk in non-muscle invasive bladder cancer (NMIBC) is essential for patient counseling and risk-adapted management. However, conventional models fail to account for the decrease in baseline risk over time. We therefore examined the conditional survival free of recurrence and progression in older adults with NMIBC to develop a dynamic risk prediction model.
Methods
We identified patients 66 to 89 years with Ta/Tis/T1 cN0 cM0 urothelial bladder cancer treated with transurethral resection of bladder tumor (TURBT) between 2000 and 2017 in SEER-Medicare. Conditional recurrence-free (RFS) and progression-free (PFS) survival were estimated using the Kaplan–Meier method. The associations of baseline characteristics with RFS and PFS at prespecified landmark times were evaluated using Cox-proportional hazards models.
Key findings and limitations
A total of 39,862 patients were included. Of these, 26,339 (66%) had Ta, 11,758 (29%) had T1, and 1,765 (4%) had Tis-disease. Median follow-up was 65 months. The 60-month RFS and PFS increased from 0.39 and 0.85 at baseline to 0.73 and 0.89 at 24-months event-free survival. Conditional RFS rapidly improved within the first 24 months before plateauing. Patients with T1-disease demonstrated the greatest improvement in conditional RFS. On multivariable analyses, T stage and tumor grade were less predictive of RFS with longer landmark times. Limitations include measurement error and risk heterogeneity within grade and stage subgroups.
Conclusions and clinical implications
Among patients with NMIBC, recurrence and progression risks decrease with longer event-free intervals, particularly among patients at highest risk of each event as reflected by tumor stage and grade. A dynamic risk prediction model can improve patient counseling and support risk-adapted management during follow-up.
{"title":"Dynamic prognostication of non-muscle invasive bladder cancer using conditional recurrence- and progression-free survival: A SEER-Medicare analysis","authors":"Jenny Chia-Chen Chang , Agustin Perez-Londoño , Sumedh Kaul , Jamil Almohtasib , Aaron Fleishman , Ruslan Korets , Peter Chang , Andrew Wagner , Joaquim Bellmunt , Aria F. Olumi , Boris Gershman","doi":"10.1016/j.urolonc.2025.11.005","DOIUrl":"10.1016/j.urolonc.2025.11.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>Accurate prediction of recurrence and progression risk in non-muscle invasive bladder cancer (NMIBC) is essential for patient counseling and risk-adapted management. However, conventional models fail to account for the decrease in baseline risk over time. We therefore examined the conditional survival free of recurrence and progression in older adults with NMIBC to develop a dynamic risk prediction model.</div></div><div><h3>Methods</h3><div>We identified patients 66 to 89 years with Ta/Tis/T1 cN0 cM0 urothelial bladder cancer treated with transurethral resection of bladder tumor (TURBT) between 2000 and 2017 in SEER-Medicare. Conditional recurrence-free (RFS) and progression-free (PFS) survival were estimated using the Kaplan–Meier method. The associations of baseline characteristics with RFS and PFS at prespecified landmark times were evaluated using Cox-proportional hazards models.</div></div><div><h3>Key findings and limitations</h3><div>A total of 39,862 patients were included. Of these, 26,339 (66%) had Ta, 11,758 (29%) had T1, and 1,765 (4%) had Tis-disease. Median follow-up was 65 months. The 60-month RFS and PFS increased from 0.39 and 0.85 at baseline to 0.73 and 0.89 at 24-months event-free survival. Conditional RFS rapidly improved within the first 24 months before plateauing. Patients with T1-disease demonstrated the greatest improvement in conditional RFS. On multivariable analyses, T stage and tumor grade were less predictive of RFS with longer landmark times. Limitations include measurement error and risk heterogeneity within grade and stage subgroups.</div></div><div><h3>Conclusions and clinical implications</h3><div>Among patients with NMIBC, recurrence and progression risks decrease with longer event-free intervals, particularly among patients at highest risk of each event as reflected by tumor stage and grade. A dynamic risk prediction model can improve patient counseling and support risk-adapted management during follow-up.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 119.e7-119.e16"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725645","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 : 2026-02-01Epub Date: 2025-12-09DOI: 10.1016/j.urolonc.2025.11.009
Luca Afferi M.D., M.P.H. , Angelo Territo M.D., Ph.D. , Andrea Gallioli M.D. , Paolo Verri M.D. , Giuseppe Basile M.D. , Alessandro Uleri M.D. , Donato Cannoletta M.D. , Marta Casadevall M.D. , Pietro Diana M.D. , Pavel Gavrilov M.D. , Yolanda Arce M.D. , Josep Maria Gaya M.D. , Joan Palou Prof. , Ferran Algaba Arrea M.D. , Alberto Breda M.D., Ph.D.
Purpose
The use of intraoperative diagnostic during ureterorenoscopy (URS) for upper tract urothelial cancer (UTUC) may assist in deciding between kidney-sparing or radical surgical approaches. We assessed the diagnostic performance of confocal microscopy (CM) using the Vivascope CM system compared to conventional histopathology.
Methods
This prospective feasibility cohort study included patients undergoing URS for suspected UTUC or during UTUC follow-up between May and August 2022. Each biopsy was analyzed first with the Vivascope CM, followed by conventional histopathology. The primary outcome was the UTUC detection rate with the VivaScope CM and conventional histopathological analysis, considering conventional analysis as the gold standard. Concordance between Vivascope CM and conventional histopathology in terms of high-grade UTUC was reported in terms of raw numbers and proportions. Analyses were conducted per biopsy sample and per patient.
Results
Ten patients underwent URS, with a total of fourteen biopsy samples. Suspicion of UTUC emerged in four (28.6%) cases because of hematuria and in four (28.6%) cases by CT-scan, while the remaining 6 cases (42.9%) underwent URS during the follow-up for UTUC. Per-biopsy analysis showed a cancer detection rate of 70% using Vivascope CM and a high-grade concordance of 50%. Among 5 CM high-grade cases, 2 were downgraded; 1 low-grade case was upgraded by conventional histopathology. Per-patient analysis showed a cancer detection rate of 77.8% using Vivascope CM and a high-grade concordance of 66.7%. Among 5 high-grade patients classified by CM, one was downgraded by conventional analysis, while one low-grade case was upgraded by conventional analysis. Vivascope CM produced artifacts that prevented histological analysis in 2 cases. The main limitation of current study is the low sample size.
Conclusions
VivaScope CM shows promise as an intraoperative tool for UTUC detection during URS. However, its performance in terms of tumor grading was limited in this preliminary experience. Larger, blinded studies, preferably including multiple biopsies per UTUC lesion, are needed to confirm the diagnostic accuracy of VivaScope CM and better define its potential role in clinical decision-making during URS.
{"title":"Ex-vivo digital pathological imaging with the Vivascope confocal microscopy for intraoperative diagnostics during ureterorenoscopy for upper tract urothelial cancer","authors":"Luca Afferi M.D., M.P.H. , Angelo Territo M.D., Ph.D. , Andrea Gallioli M.D. , Paolo Verri M.D. , Giuseppe Basile M.D. , Alessandro Uleri M.D. , Donato Cannoletta M.D. , Marta Casadevall M.D. , Pietro Diana M.D. , Pavel Gavrilov M.D. , Yolanda Arce M.D. , Josep Maria Gaya M.D. , Joan Palou Prof. , Ferran Algaba Arrea M.D. , Alberto Breda M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.11.009","DOIUrl":"10.1016/j.urolonc.2025.11.009","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of intraoperative diagnostic during ureterorenoscopy (URS) for upper tract urothelial cancer (UTUC) may assist in deciding between kidney-sparing or radical surgical approaches. We assessed the diagnostic performance of confocal microscopy (CM) using the Vivascope CM system compared to conventional histopathology.</div></div><div><h3>Methods</h3><div>This prospective feasibility cohort study included patients undergoing URS for suspected UTUC or during UTUC follow-up between May and August 2022. Each biopsy was analyzed first with the Vivascope CM, followed by conventional histopathology. The primary outcome was the UTUC detection rate with the VivaScope CM and conventional histopathological analysis, considering conventional analysis as the gold standard. Concordance between Vivascope CM and conventional histopathology in terms of high-grade UTUC was reported in terms of raw numbers and proportions. Analyses were conducted <em>per biopsy sample</em> and <em>per patient.</em></div></div><div><h3>Results</h3><div>Ten patients underwent URS, with a total of fourteen biopsy samples. Suspicion of UTUC emerged in four (28.6%) cases because of hematuria and in four (28.6%) cases by CT-scan, while the remaining 6 cases (42.9%) underwent URS during the follow-up for UTUC. Per-biopsy analysis showed a cancer detection rate of 70% using Vivascope CM and a high-grade concordance of 50%. Among 5 CM high-grade cases, 2 were downgraded; 1 low-grade case was upgraded by conventional histopathology. Per-patient analysis showed a cancer detection rate of 77.8% using Vivascope CM and a high-grade concordance of 66.7%. Among 5 high-grade patients classified by CM, one was downgraded by conventional analysis, while one low-grade case was upgraded by conventional analysis. Vivascope CM produced artifacts that prevented histological analysis in 2 cases. The main limitation of current study is the low sample size.</div></div><div><h3>Conclusions</h3><div>VivaScope CM shows promise as an intraoperative tool for UTUC detection during URS. However, its performance in terms of tumor grading was limited in this preliminary experience. Larger, blinded studies, preferably including multiple biopsies per UTUC lesion, are needed to confirm the diagnostic accuracy of VivaScope CM and better define its potential role in clinical decision-making during URS.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 120.e13-120.e19"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725620","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}
According to European Association of Urology (EAU) guidelines, nonmuscle-invasive bladder cancer (NMIBC) is stratified by pathological stage and three clinical risk factors (age >70, size >3 cm, multiple lesions). High-grade (HG) Ta can be categorized as intermediate-risk (IR) or high-risk (HR). However, the 2021 EAU stratification is based on non-BCG-treated patients. This study investigated the predictive value of EAU risk groups and factors in TaHG treated with BCG.
Methods
We retrospectively reviewed NMIBC patients treated with BCG from 2005 to 2022. Patients were stratified by EAU 2021 risk groups. The primary endpoint was HG recurrence-free survival (RFS).
Results
Among 163 TaHG patients, 84 (54%) had one risk factor, 40 (23%) two, and 8 (4%) three. According to EAU 2021, 71% (115) were IR and 29% (48) HR. Median follow-up was 37 months (IQR 19–64). Three patients progressed to MIBC or M+. Three-year HG RFS was 84% (95% CI: 69–96), 80% (95% CI: 68–87), 83% (95% CI: 66–92), and 87% (95% CI: 38–98) for patients with 0, 1, 2, and 3 risk factors, respectively (P = 0.85). For IR and HR groups, 3-year HG RFS was 81% (95% CI: 76–90) and 84% (95% CI: 68–92) (P = 0.97). At Cox regression analysis, neither the number of risk factors nor HR classification was a predictor of HG recurrence (P = 0.9).
Conclusions
Progression to MIBC was rare in our real-world cohort of BCG-treated TaHG NMIBC, while HG recurrence rates mirrored those of T1HG cases. Neither the EAU 2021 risk groups nor individual clinical RFs predicted HG recurrence effectively. Development of recurrence-based risk models for TaHG NMIBC is therefore warranted.
{"title":"Assessing risk stratification in Bacillus Calmette–Guérin–treated high-grade Ta nonmuscle-invasive bladder cancer patients","authors":"Alessio Finocchiaro M.D. , Roberto Contieri M.D. , Andrea Piccolini M.D. , Pietro Brin M.D. , Stefano Moretto M.D. , Filippo Dagnino M.D. , Muhannad Aljoulani M.D. , Alessandro Uleri M.D. , Pierpaolo Avolio M.D. , Edoardo Beatrici M.D. , Stefano Mancon M.D. , Marco Paciotti M.D. , Vittorio Fasulo M.D. , Alberto Saita M.D. , Paolo Casale M.D. , Giovanni Lughezzani M.D. , Nicolò Buffi M.D. , Massimo Lazzeri PhD , Rodolfo Hurle M.D.","doi":"10.1016/j.urolonc.2025.11.003","DOIUrl":"10.1016/j.urolonc.2025.11.003","url":null,"abstract":"<div><h3>Purpose</h3><div>According to European Association of Urology (EAU) guidelines, nonmuscle-invasive bladder cancer (NMIBC) is stratified by pathological stage and three clinical risk factors (age >70, size >3 cm, multiple lesions). High-grade (HG) Ta can be categorized as intermediate-risk (IR) or high-risk (HR). However, the 2021 EAU stratification is based on non-BCG-treated patients. This study investigated the predictive value of EAU risk groups and factors in TaHG treated with BCG.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed NMIBC patients treated with BCG from 2005 to 2022. Patients were stratified by EAU 2021 risk groups. The primary endpoint was HG recurrence-free survival (RFS).</div></div><div><h3>Results</h3><div>Among 163 TaHG patients, 84 (54%) had one risk factor, 40 (23%) two, and 8 (4%) three. According to EAU 2021, 71% (115) were IR and 29% (48) HR. Median follow-up was 37 months (IQR 19–64). Three patients progressed to MIBC or M+. Three-year HG RFS was 84% (95% CI: 69–96), 80% (95% CI: 68–87), 83% (95% CI: 66–92), and 87% (95% CI: 38–98) for patients with 0, 1, 2, and 3 risk factors, respectively (<em>P</em> = 0.85). For IR and HR groups, 3-year HG RFS was 81% (95% CI: 76–90) and 84% (95% CI: 68–92) (<em>P</em> = 0.97). At Cox regression analysis, neither the number of risk factors nor HR classification was a predictor of HG recurrence (<em>P</em> = 0.9).</div></div><div><h3>Conclusions</h3><div>Progression to MIBC was rare in our real-world cohort of BCG-treated TaHG NMIBC, while HG recurrence rates mirrored those of T1HG cases. Neither the EAU 2021 risk groups nor individual clinical RFs predicted HG recurrence effectively. Development of recurrence-based risk models for TaHG NMIBC is therefore warranted.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 119.e1-119.e6"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640373","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 : 2026-02-01Epub Date: 2025-11-17DOI: 10.1016/j.urolonc.2025.10.024
Saime Ozbek Sebin M.D., Ph.D. , Yılmaz Aksoy M.D. , Ahmet Emre Cinislioglu M.D. , Ahmet Utku Kukus M.D. , Basak Gulakar M.Sc. , Ahmet Selim Aksoy M.D. , Esra Laloglu M.D. , Mustafa Yagmur M.D.
Aim
The second most frequent kind of cancer in males is prostate cancer (CaP), with high mortality and morbidity rates due to false negatives and positives in biochemical tests used in early diagnosis. This study investigated whether serum vaspin and myonectin levels can serve as potential biomarkers for CaP diagnosis and staging.
Method
A total of 213 men, 50 healthy controls, 72 BPH patients, and 91 CaP patients, who applied to the Urology clinic and volunteered to participate in the study, were included. Of the 91 CaP patients, 51 had local, 20 locally advanced, and 20 metastatic CaP.
Results
Serum vaspin and myonectin values were higher in CaP than in BPH and control groups. Compared to patients with local and locally advanced CaP, those with metastatic CaP had considerably greater vaspin levels. For distinguishing CaP from controls, vaspin demonstrated an AUC of 0.772 (sensitivity 68%, specificity 78%). Importantly, for discriminating metastatic CaP from nonmetastatic disease, vaspin achieved an AUC of 0.90 (sensitivity 85%, specificity 82%).
Conclusion
The findings of this study demonstrate that serum vaspin exhibited superior diagnostic performance compared to prostate-specific antigen (PSA) in distinguishing CaP cases from controls (AUC = 0.772). Moreover, vaspin concentrations increased progressively with advancing disease stages, achieving an AUC of 0.90 for discriminating metastatic disease, highlighting its potential utility not only in diagnosis but also in non-invasive staging. The diagnostic performance of myonectin appeared favorable compared to PSA; however, as it showed no association with disease staging, this finding should be interpreted with caution.
{"title":"Emerging roles of vaspin and myonectin as novel biomarkers in prostate cancer diagnosis and staging vaspin and myonectin as novel biomarkers for prostate cancer","authors":"Saime Ozbek Sebin M.D., Ph.D. , Yılmaz Aksoy M.D. , Ahmet Emre Cinislioglu M.D. , Ahmet Utku Kukus M.D. , Basak Gulakar M.Sc. , Ahmet Selim Aksoy M.D. , Esra Laloglu M.D. , Mustafa Yagmur M.D.","doi":"10.1016/j.urolonc.2025.10.024","DOIUrl":"10.1016/j.urolonc.2025.10.024","url":null,"abstract":"<div><h3>Aim</h3><div>The second most frequent kind of cancer in males is prostate cancer (CaP), with high mortality and morbidity rates due to false negatives and positives in biochemical tests used in early diagnosis. This study investigated whether serum vaspin and myonectin levels can serve as potential biomarkers for CaP diagnosis and staging.</div></div><div><h3>Method</h3><div>A total of 213 men, 50 healthy controls, 72 BPH patients, and 91 CaP patients, who applied to the Urology clinic and volunteered to participate in the study, were included. Of the 91 CaP patients, 51 had local, 20 locally advanced, and 20 metastatic CaP.</div></div><div><h3>Results</h3><div>Serum vaspin and myonectin values were higher in CaP than in BPH and control groups. Compared to patients with local and locally advanced CaP, those with metastatic CaP had considerably greater vaspin levels. For distinguishing CaP from controls, vaspin demonstrated an AUC of 0.772 (sensitivity 68%, specificity 78%). Importantly, for discriminating metastatic CaP from nonmetastatic disease, vaspin achieved an AUC of 0.90 (sensitivity 85%, specificity 82%).</div></div><div><h3>Conclusion</h3><div>The findings of this study demonstrate that serum vaspin exhibited superior diagnostic performance compared to prostate-specific antigen (PSA) in distinguishing CaP cases from controls (AUC = 0.772). Moreover, vaspin concentrations increased progressively with advancing disease stages, achieving an AUC of 0.90 for discriminating metastatic disease, highlighting its potential utility not only in diagnosis but also in non-invasive staging. The diagnostic performance of myonectin appeared favorable compared to PSA; however, as it showed no association with disease staging, this finding should be interpreted with caution.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 125.e11-125.e22"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145550996","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 : 2026-02-01Epub Date: 2025-11-11DOI: 10.1016/j.urolonc.2025.10.009
Cathy D. Vocke Ph.D. , Christopher J. Ricketts Ph.D. , Lidenys O’Brien B.S.N., R.N. , Alexandra P. Lebensohn M.S., C.G.C. , Nityam Rathi M.D. , Deborah Nielsen B.S.N., R.N. , Rabindra Gautam D.H.S. , Svetlana D. Pack Ph.D. , Mark Raffeld M.D. , Emily Y. Chew M.D. , Prashant Chittiboina M.D., M.P.H. , Ashkan A. Malayeri M.D. , Mary R. Welch M.D. , Maria J. Merino M.D. , Ramaprasad Srinivasan M.D., Ph.D. , Mark W. Ball M.D. , W. Marston Linehan M.D.
Objective
We describe a large family of patients with canonical Von Hippel-Lindau (VHL) manifestations, including central nervous system and retinal hemangioblastomas, clear cell renal cell carcinoma (ccRCC), pancreatic neuroendocrine tumors, and pheochromocytomas, all who lacked any detectable alteration within the VHL gene. Analysis of a ccRCC demonstrated a novel p.E92G variant in the Elongin C gene, ELOC, a known ccRCC tumor suppressor gene. We aim to confirm that the ELOC variant is responsible for the VHL manifestations in this family.
Methods
Germline testing and tumor analysis were performed to assess the molecular alterations in the lesions in this family. Abdominal imaging was used to determine the sizes of VHL-related lesions.
Results
We demonstrated this ELOC p.E92G variant was a germline alteration and was present in each affected individual that received genetic testing, demonstrating co-segregation of variant and disease. Analysis of tumors excised from 2 patients demonstrated loss of heterozygosity for the ELOC variant and single copy chromosomal loss of chromosome 8 that encodes the ELOC gene, consistent with inactivation of a tumor suppressor gene. Two patients who received Belzutifan showed a decrease in size of their kidney, pancreatic, and spinal lesions and 1 showed improvement of retinal manifestations.
Conclusion
These findings indicate that the p.E92G ELOC variant is responsible for the VHL manifestations in this family, and that these tumors are being driven by loss of the VCB-Cul2 E3-ubiquitin ligase complex activity
{"title":"Multigenerational VHL family characterized by pathogenic germline ELOC variant: Response to belzutifan","authors":"Cathy D. Vocke Ph.D. , Christopher J. Ricketts Ph.D. , Lidenys O’Brien B.S.N., R.N. , Alexandra P. Lebensohn M.S., C.G.C. , Nityam Rathi M.D. , Deborah Nielsen B.S.N., R.N. , Rabindra Gautam D.H.S. , Svetlana D. Pack Ph.D. , Mark Raffeld M.D. , Emily Y. Chew M.D. , Prashant Chittiboina M.D., M.P.H. , Ashkan A. Malayeri M.D. , Mary R. Welch M.D. , Maria J. Merino M.D. , Ramaprasad Srinivasan M.D., Ph.D. , Mark W. Ball M.D. , W. Marston Linehan M.D.","doi":"10.1016/j.urolonc.2025.10.009","DOIUrl":"10.1016/j.urolonc.2025.10.009","url":null,"abstract":"<div><h3>Objective</h3><div>We describe a large family of patients with canonical Von Hippel-Lindau (VHL) manifestations, including central nervous system and retinal hemangioblastomas, clear cell renal cell carcinoma (ccRCC), pancreatic neuroendocrine tumors, and pheochromocytomas, all who lacked any detectable alteration within the VHL gene. Analysis of a ccRCC demonstrated a novel p.E92G variant in the Elongin C gene, <em>ELOC</em>, a known ccRCC tumor suppressor gene. We aim to confirm that the <em>ELOC</em> variant is responsible for the VHL manifestations in this family.</div></div><div><h3>Methods</h3><div>Germline testing and tumor analysis were performed to assess the molecular alterations in the lesions in this family. Abdominal imaging was used to determine the sizes of VHL-related lesions.</div></div><div><h3>Results</h3><div>We demonstrated this <em>ELOC</em> p.E92G variant was a germline alteration and was present in each affected individual that received genetic testing, demonstrating co-segregation of variant and disease. Analysis of tumors excised from 2 patients demonstrated loss of heterozygosity for the <em>ELOC</em> variant and single copy chromosomal loss of chromosome 8 that encodes the <em>ELOC</em> gene, consistent with inactivation of a tumor suppressor gene. Two patients who received Belzutifan showed a decrease in size of their kidney, pancreatic, and spinal lesions and 1 showed improvement of retinal manifestations.</div></div><div><h3>Conclusion</h3><div>These findings indicate that the p.E92G <em>ELOC</em> variant is responsible for the VHL manifestations in this family, and that these tumors are being driven by loss of the VCB-Cul2 E3-ubiquitin ligase complex activity</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 120.e21-120.e27"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507234","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 : 2026-02-01Epub Date: 2025-05-30DOI: 10.1016/j.urolonc.2025.04.008
Simon John Christoph Soerensen M.D. , Eugene Shkolyar M.D. , Benjamin I. Chung M.D., M.S. , John T. Leppert M.D., M.S.
The early detection of small renal masses challenges us to distinguish between small renal masses appropriate for early treatment and those that can be safely managed conservatively. Clinicians caring for patients with small renal masses can draw numerous parallels to the evolution of the evaluation and treatment of patients diagnosed with low-risk prostate cancer. Reflexive treatment can have both serious side effects and long-term health implications that may outweigh the potential benefits—especially among those with limited life expectancy or significant comorbidities. In this article, we present current practices in the management of small renal masses that warrant a new perspective, and we propose a new Tumor-Organ Patient (TOP) conceptual framework to reduce overtreatment of small renal masses. The TOP model incorporates tumor biology, but also considers the patient’s risk for loss of kidney function (the organ), as well as the patient’s overall health (e.g. age, comorbidity, life expectancy). As we continue to refine our understanding of small renal masses, it is critical to learn the lessons of low-risk prostate cancer and to first “do no harm.”
{"title":"Reality check: The management of small renal masses in 2025 and beyond: Learning from the evolution of prostate cancer care","authors":"Simon John Christoph Soerensen M.D. , Eugene Shkolyar M.D. , Benjamin I. Chung M.D., M.S. , John T. Leppert M.D., M.S.","doi":"10.1016/j.urolonc.2025.04.008","DOIUrl":"10.1016/j.urolonc.2025.04.008","url":null,"abstract":"<div><div><span>The early detection of small renal masses challenges us to distinguish between small renal masses appropriate for early treatment and those that can be safely managed conservatively. Clinicians caring for patients with small renal masses can draw numerous parallels to the evolution of the evaluation and treatment of patients diagnosed with low-risk </span>prostate cancer. Reflexive treatment can have both serious side effects and long-term health implications that may outweigh the potential benefits—especially among those with limited life expectancy or significant comorbidities. In this article, we present current practices in the management of small renal masses that warrant a new perspective, and we propose a new Tumor-Organ Patient (TOP) conceptual framework to reduce overtreatment of small renal masses. The TOP model incorporates tumor biology, but also considers the patient’s risk for loss of kidney function (the organ), as well as the patient’s overall health (e.g. age, comorbidity, life expectancy). As we continue to refine our understanding of small renal masses, it is critical to learn the lessons of low-risk prostate cancer and to first “do no harm.”</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 73-78"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188076","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}
Renal angiomyolipoma (AML) is a benign perivascular epithelioid cell neoplasm that is often associated with tuberous sclerosis complex (TSC). Epithelioid AML (eAML), a very rare and potentially malignant variant, can be challenging to radiologically differentiate from benign AML and other renal tumors. Adverse histological features have previously been associated to poorer oncological outcomes. This study aimed to characterize this rare disease entity and validate previously reported adverse prognostic factors.
Methods
This multicenter, retrospective cohort study analyzed 76 patients diagnosed with eAML between 2001 and 2024 across 15 participating centers. Inclusion criteria were histological diagnosis of eAML with negative cytokeratin markers and positive melanocytic markers. Patients were stratified according to previously described adverse pathological features.
Results
A total of 76 patients were studied. Most were female (70%), with a median age of 48 years and, 19 patients had TSC. Median tumor size was 45 mm, with a rate of atypical epithelioid cells >70% in 26 (34.2%) patients. According to the Nese’s and Brimo’s classifications, 4% and 14% of patients were at high risk, respectively. During a median follow- up of 30-months, 5 (6.7 %) patients developed metastases, and 4 (5.3 %) died. At univariable analysis, the number of adverse pathological risk factors, according to both classifications, was significantly associated with worse metastasis free survival (MFS) and cancer specific survival (CSS). Due to the low number of events, a multivariable analysis was not carried out.
Conclusions
eAML is extremely rare, and primarily affects middle-aged women. This cohort validated previously described pathological risk factors for worse prognosis, suggesting that patients with multiple adverse features may require more intensive follow-up.
{"title":"Renal epithelioid angiomyolipoma: A multi-institutional, international cohort study with emphasis on clinicopathologic prognostic indicators","authors":"Angela Pecoraro , Daniele Amparore , Riccardo Bertolo , Nicolas Branger , Anna Caliò , Umberto Carbonara , Pietro Diana , Alfredo Distante , Selcuk Erdem , Michele Marchioni , Gaelle Margue , Guido Martignoni , Constantijn H.J. Muselaers , Nicola Pavan , Hannah Warren , Zhenjie Wu , Maarten Albersen , Maria Rosaria Raspollini , Riccardo Campi , Eduard Roussel","doi":"10.1016/j.urolonc.2025.10.018","DOIUrl":"10.1016/j.urolonc.2025.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Renal angiomyolipoma (AML) is a benign perivascular epithelioid cell neoplasm that is often associated with tuberous sclerosis complex (TSC). Epithelioid AML (eAML), a very rare and potentially malignant variant, can be challenging to radiologically differentiate from benign AML and other renal tumors. Adverse histological features have previously been associated to poorer oncological outcomes. This study aimed to characterize this rare disease entity and validate previously reported adverse prognostic factors.</div></div><div><h3>Methods</h3><div>This multicenter, retrospective cohort study analyzed 76 patients diagnosed with eAML between 2001 and 2024 across 15 participating centers. Inclusion criteria were histological diagnosis of eAML with negative cytokeratin markers and positive melanocytic markers. Patients were stratified according to previously described adverse pathological features.</div></div><div><h3>Results</h3><div>A total of 76 patients were studied. Most were female (70%), with a median age of 48 years and, 19 patients had TSC. Median tumor size was 45 mm, with a rate of atypical epithelioid cells >70% in 26 (34.2%) patients. According to the Nese’s and Brimo’s classifications, 4% and 14% of patients were at high risk, respectively. During a median follow- up of 30-months, 5 (6.7 %) patients developed metastases, and 4 (5.3 %) died. At univariable analysis, the number of adverse pathological risk factors, according to both classifications, was significantly associated with worse metastasis free survival (MFS) and cancer specific survival (CSS). Due to the low number of events, a multivariable analysis was not carried out.</div></div><div><h3>Conclusions</h3><div>eAML is extremely rare, and primarily affects middle-aged women. This cohort validated previously described pathological risk factors for worse prognosis, suggesting that patients with multiple adverse features may require more intensive follow-up.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 122.e11-122.e17"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662186","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 : 2026-02-01Epub Date: 2025-11-16DOI: 10.1016/j.urolonc.2025.10.019
Alice Semerjian M.D. , Emily Fisher M.D. , Amit Patel M.D. , Anna Johnson M.S. , Monica Van Til M.S. , Sabrina L. Noyes B.S. , Brian Seifman M.D. , William K. Johnston M.D. , Jason Hafron M.D. , Thomas Maatman M.D. , Craig G. Rogers M.D. , Brian R. Lane M.D., Ph.D.
Purpose
To determine opportunities for quality improvement (QI) in patient selection for radical nephrectomy (RN) for cT1 renal masses (cT1RM).
Materials and Methods
The MUSIC (Michigan Urological Surgery Improvement Collaborative) registry was queried for RN performed for any localized RM ≤4 cm (cT1aRM) or low/intermediate/unrecorded complexity RM 4 to 7 cm (cT1bRM). Eight experienced kidney surgeons reviewed characteristics (age, GFR, medical comorbidities, RENAL score, tumor size, and more) of de-identified cases. Each reviewer provided a score regarding opportunity for QI (none = 0, minor = 1, moderate = 2, major = 3) that were averaged.
Results
171 cases met inclusion criteria, including 77 cT1aRM and 94 cT1bRM. Urologists agreed on a score of no (0) or minor (0.1–1) QI opportunities in 40% (n = 68) and 41% (n = 70) of cases, respectively. These patients had (1) ≥1 of the following features: on dialysis; elderly, comorbid, or anticoagulated with normal GFR; (2) cT1bRM and RENAL ≥8; (3) not amenable to partial nephrectomy (PN) or biopsy based on location or cystic nature; or (4) attempted PN. Thirty-three cases had moderate (14%) or major (4%) QI opportunities including 30% of cT1aRM and 11% of reviewed cT1bRM. Case characteristics included: smaller and/or lower complexity tumors, younger age, baseline CKD, and/or would have benefitted from active surveillance and/or pretreatment biopsy.
Conclusions
Surgeon-reviewers identified moderate/major opportunities for QI in 33 patients that underwent RN who may have been spared from kidney loss. Kidney loss can be prevented by considering active surveillance, confirmatory imaging, renal mass biopsy, and/or kidney-sparing interventions in patients with T1aRM, low/intermediate complexity T1bRM, young patients, and patients with CKD.
目的：确定cT1肾肿块（cT1RM）根治性肾切除术（RN）患者选择质量改善（QI）的机会。材料和方法：查询MUSIC （Michigan Urological Surgery Improvement Collaborative）注册表，查询任何局限性RM≤4 cm （cT1aRM）或低/中/未记录复杂性RM 4至7 cm （cT1bRM）的RN。8位经验丰富的肾脏外科医生回顾了去识别病例的特征（年龄、GFR、医疗合并症、肾评分、肿瘤大小等）。每个审稿人提供了一个关于QI的平均得分（无= 0，次要= 1，中等= 2，主要= 3）。结果：171例符合纳入标准，其中cT1aRM 77例，cT1bRM 94例。泌尿科医生分别认为40% （n = 68）和41% （n = 70）的病例没有(0)或轻微（0.1-1）气机会。这些患者具有(1)以下特征中≥1项：透析；老年、合并症或抗凝血但GFR正常；(2) cT1bRM和RENAL≥8；(3)不适合基于位置或囊性的部分肾切除术（PN）或活检；或(4)尝试的PN。33例有中度（14%）或重度（4%）QI机会，包括30%的cT1aRM和11%的cT1bRM。病例特征包括：较小和/或复杂性较低的肿瘤，年龄较小，基线CKD，和/或将受益于主动监测和/或预处理活检。结论：外科医生在33例接受RN的患者中发现了中度/重度QI的机会，这些患者可能没有肾丢失。对于T1aRM、低/中等复杂性T1bRM、年轻患者和CKD患者，可以通过积极监测、确认性影像学、肾肿块活检和/或保肾干预来预防肾损失。
{"title":"Utilization of radical nephrectomy for patients with clinical stage T1 renal masses: Evaluation of opportunities for quality improvement","authors":"Alice Semerjian M.D. , Emily Fisher M.D. , Amit Patel M.D. , Anna Johnson M.S. , Monica Van Til M.S. , Sabrina L. Noyes B.S. , Brian Seifman M.D. , William K. Johnston M.D. , Jason Hafron M.D. , Thomas Maatman M.D. , Craig G. Rogers M.D. , Brian R. Lane M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.10.019","DOIUrl":"10.1016/j.urolonc.2025.10.019","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine opportunities for quality improvement (QI) in patient selection for radical nephrectomy (RN) for cT1 renal masses (cT1RM).</div></div><div><h3>Materials and Methods</h3><div>The MUSIC (Michigan Urological Surgery Improvement Collaborative) registry was queried for RN performed for any localized RM ≤4 cm (cT1aRM) or low/intermediate/unrecorded complexity RM 4 to 7 cm (cT1bRM). Eight experienced kidney surgeons reviewed characteristics (age, GFR, medical comorbidities, RENAL score, tumor size, and more) of de-identified cases. Each reviewer provided a score regarding opportunity for QI (none = 0, minor = 1, moderate = 2, major = 3) that were averaged.</div></div><div><h3>Results</h3><div>171 cases met inclusion criteria, including 77 cT1aRM and 94 cT1bRM. Urologists agreed on a score of no (0) or minor (0.1–1) QI opportunities in 40% (<em>n</em> = 68) and 41% (<em>n</em> = 70) of cases, respectively. These patients had (1) ≥1 of the following features: on dialysis; elderly, comorbid, or anticoagulated with normal GFR; (2) cT1bRM and RENAL ≥8; (3) not amenable to partial nephrectomy (PN) or biopsy based on location or cystic nature; or (4) attempted PN. Thirty-three cases had moderate (14%) or major (4%) QI opportunities including 30% of cT1aRM and 11% of reviewed cT1bRM. Case characteristics included: smaller and/or lower complexity tumors, younger age, baseline CKD, and/or would have benefitted from active surveillance and/or pretreatment biopsy.</div></div><div><h3>Conclusions</h3><div>Surgeon-reviewers identified moderate/major opportunities for QI in 33 patients that underwent RN who may have been spared from kidney loss. Kidney loss can be prevented by considering active surveillance, confirmatory imaging, renal mass biopsy, and/or kidney-sparing interventions in patients with T1aRM, low/intermediate complexity T1bRM, young patients, and patients with CKD.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 2","pages":"Pages 122.e19-122.e28"},"PeriodicalIF":2.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535035","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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