Urologic Oncology-seminars and Original Investigations最新文献

{"title":"PSA response to predict progression in metastatic hormone-sensitive prostate cancer (mHSPC) patients. When is the optimal time point?","authors":"Rocío Martínez-Corral ,&nbsp;Daniel Pérez-Fentes ,&nbsp;Celia Bardella-Altarriba ,&nbsp;Francisco Javier Vera-Ballesteros ,&nbsp;Arnau Abella-Serra ,&nbsp;Sergio Antón Fuente ,&nbsp;María Elena Martínez-Corral ,&nbsp;Natalia Picola-Brau ,&nbsp;Alicia López-Abad ,&nbsp;Álvaro Gómez-Ferrer ,&nbsp;Manuel Beamud-Cortés ,&nbsp;Jose Francisco Suárez-Novo ,&nbsp;Pedro Angel López-González ,&nbsp;Mireia García-Puche ,&nbsp;Ana María Álvarez-Gracia ,&nbsp;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 &gt;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> &lt; 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":"2025-11-08","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}

{"title":"Diagnostic performance of Cxbladder Triage Plus for the identification and stratification of patients at risk for urothelial carcinoma: The multicenter, prospective, observational DRIVE study","authors":"Stephen J. Savage M.D. ,&nbsp;Cesar E. Ercole M.D. ,&nbsp;George Hemstreet M.D. ,&nbsp;Andrew Leone M.D. ,&nbsp;Thomas Masterson M.D. ,&nbsp;Glen McWilliams M.D. ,&nbsp;Michael Risk M.D. ,&nbsp;Florian R. Schroeck M.D. ,&nbsp;Kelly Stratton M.D. ,&nbsp;Tony Lough Ph.D. ,&nbsp;Michel de Lange Ph.D. ,&nbsp;Kyoko Sakamoto M.D.","doi":"10.1016/j.urolonc.2025.10.008","DOIUrl":"10.1016/j.urolonc.2025.10.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Cxbladder Triage Plus provides risk stratification for the presence or absence of urothelial carcinoma (UC) in patients presenting with hematuria. Triage Plus is a multimodal urinary biomarker test that detects 5 UC-associated mRNAs and 6 DNA single-nucleotide variants from fibroblast growth factor receptor 3 and telomerase reverse transcriptase genes. The aim of this study was to provide external validation of the diagnostic performance of Triage Plus for evaluation of UC in a veterans affairs (VA) population with hematuria.</div></div><div><h3>Methods</h3><div>The multicenter, prospective, observational DRIVE study enrolled adults (≥18 years) from VA clinics presenting with gross hematuria or microhematuria. Midstream urine samples were tested with Triage Plus and with Cxbladder Triage and Detect. The primary objective was external clinical validation of the diagnostic performance of Triage Plus versus white light cystoscopy and pathological confirmation as the standard for primary UC diagnosis.</div></div><div><h3>Results</h3><div>Of 615 patients with hematuria (278 with gross hematuria, 337 with microhematuria), 48 (7.8%) had histologically confirmed UC and 587 (95.4%) had available Triage Plus results. Compared with cystoscopy, Triage Plus had sensitivity of 94% (95% confidence interval 83%–99%), specificity of 77% (73%–80%), positive predictive value (PPV) of 26% (20%–34%), negative predictive value (NPV) of 99.3% (97.3%–99.9%), and a test-negative rate (TNR) of 71% (67%–75%). Triage Plus had higher specificity, PPV, and TNR than Triage, and higher sensitivity and NPV than Detect.</div></div><div><h3>Conclusions</h3><div>Triage Plus demonstrated clinical validity in veteran patients with hematuria, with improved sensitivity and specificity compared with earlier assays.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 65.e13-65.e20"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on “Evaluation of event-free survival as a surrogate for overall survival in genitourinary rhabdomyosarcoma”","authors":"Sari Khaleel MD, MSc","doi":"10.1016/j.urolonc.2025.09.024","DOIUrl":"10.1016/j.urolonc.2025.09.024","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 55-56"},"PeriodicalIF":2.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved quality of care for testicular germ cell cancer patients by the implementation of an interdisciplinary testis cancer clinic","authors":"Nico C. Grossmann M.D. ,&nbsp;Luca Funk M.Med. (UZH) ,&nbsp;Christian D. Fankhauser M.D., M.P.H. ,&nbsp;Jörg Beyer M.D. ,&nbsp;Anja Lorch M.D. ,&nbsp;Thomas Hermanns M.D.","doi":"10.1016/j.urolonc.2025.10.007","DOIUrl":"10.1016/j.urolonc.2025.10.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Adherence to clinical guidelines in the management of testicular germ-cell cancer ensures optimal oncological outcomes, minimizes the risk of overtreatment and undertreatment, and reduces unnecessary investigations including radiographic imaging. An interdisciplinary testis cancer clinic (ITCC) in the Department of urology of the University Hospital Zürich was therefore established in 2016 led by a urologist and medical oncologist, who had both specialized in germ-cell cancer. Aside from treatment decision visits, structured follow-up schedules were integrated to guarantee guideline-conformant therapy and follow-up. We aimed to evaluate the impact of the ITCC on guideline adherence and follow-up.</div></div><div><h3>Materials and Methods</h3><div>A retrospective analysis was conducted on all testicular germ-cell cancer patients treated from 2012 to 2020 in our hospital. Patients were categorized into 2 groups: those followed prior to the establishment of the ITCC and those thereafter. We compared patient characteristics, follow-up protocols, and the compliance with guideline-recommended follow-up schedules.</div></div><div><h3>Results</h3><div>We included 143 patients, with 77 in the pre-ITCC group and 66 in the ITCC group. Adherence to clinical follow-up guidelines over a 5-year period was significantly higher in the ITCC group, with 89% completeness of the recommended consultations and diagnostics compared to only 21% in the pre-ITCC group. Additionally, the median number of computed tomography scans was significantly lower in the ITCC group during each of the 5 years of follow-up. The time between orchiectomy and start of further therapies was significantly shorter in the ITCC group (median 24 days versus 32 days, <em>P</em> &lt; 0.01) and significantly less patients were lost to follow-up (11% versus 36%, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>A well-structured ITCC can improve the quality of care of testis cancer patients by optimizing adherence to follow-up schedules and therefore expediting further therapies, reducing unnecessary diagnostics and minimizing loss to follow-up.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 72.e9-72.e14"},"PeriodicalIF":2.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of event-free survival as a surrogate for overall survival in genitourinary rhabdomyosarcoma","authors":"Zijing Cheng Ph.D. ,&nbsp;Timothy Campbell M.D. ,&nbsp;Trevor C. Hunt M.D. ,&nbsp;Ashley Li M.D. ,&nbsp;Carl Ceraolo M.D. ,&nbsp;Karen Doersch M.D., Ph.D. ,&nbsp;Jathin Bandari M.D.","doi":"10.1016/j.urolonc.2025.08.023","DOIUrl":"10.1016/j.urolonc.2025.08.023","url":null,"abstract":"<div><h3>Purpose</h3><div>Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in pediatric patients. Due to rarity, treatment advancements are infrequent and randomized controlled trials (RCTs) are challenging to conduct and interpret. Surrogate endpoints are particularly useful in RCTs for rare diseases; however, they are not always accurate or effective. Event-free survival (EFS) is a common surrogate endpoint for overall survival (OS), but has never been validated in genitourinary (GU) RMS.</div></div><div><h3>Methods</h3><div>Data from three clinical trials were pooled, including 111 subjects with GU primary sites across low-, intermediate-, and high-risk RMS. These trials employed various chemotherapy regimens ± radiation, based on risk-group. The definitive endpoint was OS and the surrogate endpoint was EFS. A 2-stage meta-analytic copula modeling approach was selected to assess surrogacy. The Plackett model was chosen to estimate treatment effects. Sensitivity analyses included convergence testing, goodness-of-fit, and leave-one-out cross-validation.</div></div><div><h3>Results</h3><div>Of 111 subjects, 56 (50.5%) were randomized into control and 55 (49.5%) into treatment arms. Surrogacy analysis revealed a moderate to strong association between EFS and OS, with trial-level associations (<span><math><msubsup><mi>R</mi><mrow><mi>t</mi><mi>r</mi><mi>i</mi><mi>a</mi><mi>l</mi></mrow><mn>2</mn></msubsup></math></span> of 1.0) showing a stronger correlation than individual-level associations (Kendall’s τ of 0.67). The surrogate threshold effect was 0.44. Robustness was limited by sample size due to disease and trial rarity.</div></div><div><h3>Conclusions</h3><div>In GU RMS, EFS is a moderate to strong surrogate endpoint for OS. These findings support its use as a surrogate endpoint, and the strength of this surrogacy may enable future clinical trial design to utilize EFS with greater emphasis than in prior studies.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 49-54"},"PeriodicalIF":2.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of PI-RADS version 2.1 vs. 2.0 for detecting clinically significant prostate cancer in biopsy-naïve men","authors":"Kathryn E. Fink ,&nbsp;Mitchell M. Huang M.D. ,&nbsp;Eric V. Li M.D. ,&nbsp;Mohammad R. Siddiqui M.D. ,&nbsp;Nicole Handa M.D. ,&nbsp;Austin Drysch ,&nbsp;Ridwan Alam M.D., M.P.H. ,&nbsp;Anugayathri Jawahar M.D. ,&nbsp;Edward M. Schaeffer M.D., Ph.D. ,&nbsp;Ashley E. Ross M.D., Ph.D. ,&nbsp;Hiten D. Patel M.D., M.P.H.","doi":"10.1016/j.urolonc.2025.10.004","DOIUrl":"10.1016/j.urolonc.2025.10.004","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate the diagnostic performance of version 2.1 of the prostate imaging reporting and data system (PI-RADS v2.1) compared to version 2.0 (PI-RADS v2.0) for detecting clinically significant prostate cancer (csPCa), we analyzed a cohort using multiparametric MRI (mpMRI). PI-RADS was developed to standardize mpMRI acquisition and interpretation, with version 2.1 introducing revisions to the assessment of transition zone (TZ) lesions aimed at improving detection of prostate cancer (PCa).</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of biopsy-naive men who underwent mpMRI between 2018 and 2022. Patients were grouped by interpretation under PI-RADS v2.0 or v2.1. The primary outcome was detection of csPCa, defined as Grade Group ≥2 on subsequent biopsy. Analyses were performed for the cohort and stratified by the region of the index lesion.</div></div><div><h3>Results</h3><div>Of 1,427 patients, 1,144 (80.2%) underwent mpMRI evaluated under v2.1 and 283 (19.8%) under v2.0. Compared to v2.0, the v2.1 group had more PI-RADS 5 lesions (21% vs. 16%) and fewer PI-RADS 1 to 2 lesions (8% vs. 14%) (<em>P</em> = 0.004). csPCa detection per patient was higher in the v2.1 group (50% vs. 43%, <em>P</em> = 0.04), driven by improved detection in the TZ (55.1% vs. 39.3%, <em>P</em> = 0.04). No significant difference was seen in the peripheral zone (PZ). Multivariable analysis showed higher csPCa detection for TZ lesions with v2.1 (OR: 1.34, 95% CI: 1.02–1.76, <em>P</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>PI-RADS v2.1 was associated with csPCa detection in TZ lesions compared to v2.0.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 72.e1-72.e7"},"PeriodicalIF":2.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 4 local anesthetic techniques for open radical cystectomy: A prospective, randomized controlled trial","authors":"Jiping Zeng MD ,&nbsp;Isamu Tachibana MD ,&nbsp;Josh Sadowski ,&nbsp;Yar Yeap MD ,&nbsp;Amy McCutchan MD ,&nbsp;Elisa Sarmiento MPH ,&nbsp;Pengyue Zhang PhD ,&nbsp;Adam Lemmon MD ,&nbsp;Brendon Burke MD ,&nbsp;Clint Cary MD, MPH, MBA ,&nbsp;Hristos Z. Kaimakliotis MD ,&nbsp;Timothy A. Masterson MD","doi":"10.1016/j.urolonc.2025.09.019","DOIUrl":"10.1016/j.urolonc.2025.09.019","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Open radical cystectomy with urinary diversion is associated with high morbidity, partly due to perioperative opioid use and delayed return of bowel function. We designed a prospective, randomized controlled trial to compare 4 common perioperative analgesic techniques.</div></div><div><h3>Methods</h3><div>A total of 160 patients between 2019 and 2021 were prospectively enrolled and randomized into 4 groups – thoracic epidural anesthesia (TEA), rectus sheath block (RSB), surgeon infiltration (SI) with either liposomal bupivacaine (LB) or standard bupivacaine (SB). The primary outcome was Visual Analog Scale (VAS) scores at different time points. Secondary outcomes including opioid use, incidence of treatment related side effects, and length of stay (LOS) were measured.</div></div><div><h3>Results</h3><div>There was no statistical difference regarding VAS scores among 4 groups at 24-, 48, or 96-hour marks. At 72-hour, both TEA and SI with SB had lower VAS scores compared to SI with LB at rest. Compared to SI with SB, TEA had lower cumulative opioid use in first 72 hours postoperatively. The opioid use at individual timepoint, treated related side effects and LOS were similar across groups. TEA was not associated with increased incidence of hypotension, AKI, or delayed ambulation. The ileus rates were higher in SI groups than in TEA and RSB groups (not statistically significant). Limitations include variability in analgesic techniques and timing to transition to PO opioids.</div></div><div><h3>Conclusions</h3><div>Four analgesic methods perform similarly regarding pain control, opioid use, treatment related side effects and LOS in radical cystectomy.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 64.e7-64.e14"},"PeriodicalIF":2.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145422002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding the article “Enhanced diagnostic accuracy of micro-ultrasound in prostate cancer detection: An updated series from a single-center prospective study”","authors":"Huseyin Besiroglu,&nbsp;Mustafa Kadihasanoglu","doi":"10.1016/j.urolonc.2025.08.019","DOIUrl":"10.1016/j.urolonc.2025.08.019","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Page 59"},"PeriodicalIF":2.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis evaluating the incidence, microbiological profile and risk factors associated with urinary tract infection after radical cystectomy","authors":"Alberto Artiles Medina ,&nbsp;César Mínguez Ojeda ,&nbsp;José Daniel Subiela ,&nbsp;David López Curtis ,&nbsp;Ana Domínguez Gutiérrez ,&nbsp;Sandra Chamorro Tojeiro ,&nbsp;Irene De La Parra Sánchez ,&nbsp;Miguel Ángel Jiménez Cidre ,&nbsp;Victoria Gómez Dos Santos ,&nbsp;Francisco Javier Burgos Revilla","doi":"10.1016/j.urolonc.2025.09.027","DOIUrl":"10.1016/j.urolonc.2025.09.027","url":null,"abstract":"<div><div>We aimed to evaluate the incidence, microbiological patterns and risk factors of UTIs following radical cystectomy (RC). The study was registered with PROSPERO (CRD42024586612). We searched the PubMed/MEDLINE and Embase databases for articles published until December 2024. The selected records consisted of observational studies with at least two of the following main outcomes: UTI incidence, urosepsis rate, positive urine culture rate, isolated pathogens in urine culture and UTI-associated factors in the 90-day period after RC. Risk of bias was assessed for single-arm and nonrandomised comparative studies. We identified 1845 records and included 17 studies, comprising 18,976 patients who underwent RC. Overall, the pooled 90-day UTI incidence after RC was 21% (95% CI, 17%–25%). Among patients who develop UTI, pooled incidence of urosepsis was 25% (95% CI, 19%–32%). Pooled urine culture positivity reached 79% (95% CI, 74%–84%), with a 25% (95% CI, 17%–34%) and 11% (95% CI, 6%–18%) rate of polymicrobial and fungal infections, respectively.</div><div>Pooled prevalence of common bacterial isolates obtained from urine cultures was 26% (95% CI, 18%–35%) for <em>Escherichia coli</em>, 26% (95% CI, 17%–35%) for <em>Enterococcus</em> spp. and 12% (95% CI, 8%–16%) for <em>Klebsiella pneumoniae</em>. Risk factors for 90-day UTI after RC included estimated glomerular filtration rate &lt;60 ml/min/1.73 m² (RR 1.75, 95% CI, 1.44–2.12), orthotopic neobladder (RR 2.02, 95% CI, 1.17–3.48), postoperative hydronephrosis (RR 1.73, 95% CI, 1.28–2.34) and ureterointestinal stricture (RR 1.98, 95% CI, 1.65–2.38). UTIs are common after RC and clinically present as urosepsis in nearly 25% of cases. A high rate of mixed infections is observed, and the rate of fungal infection can reach 10%. These findings are important for patient counselling and may be utilised to guide empirical antibiotic treatment in everyday clinical practice.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 12-26"},"PeriodicalIF":2.3,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145402105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular subtyping of advanced bladder cancer patients and patient-derived organoids based on a 3-marker immunohistochemistry approach to evaluate chemotherapy sensitivity","authors":"Bastiaan J. Viergever M.Sc. ,&nbsp;Alba C. Zuidema Ph.D. ,&nbsp;Trudy Jonges M.D. ,&nbsp;Susanne J. Van Schelven B.Sc. ,&nbsp;Denise Westland B.Sc. ,&nbsp;Eric Kalkhoven Ph.D. ,&nbsp;Onno Kranenburg Ph.D. ,&nbsp;Richard P. Meijer M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.09.023","DOIUrl":"10.1016/j.urolonc.2025.09.023","url":null,"abstract":"<div><h3>Background</h3><div>Bladder cancer is among the top ten most common cancers globally and one of the most expensive to treat, primarily due to high recurrence rates stemming from significant heterogeneity and mutational rates. The standard treatment, cisplatin-based combination chemotherapy, yields only 40–56% clinical responses, highlighting the need for improved patient stratification to enable precision treatments. Currently, in general practice patient stratification is based on physical fitness and immunohistopathological characterization. While molecular subtyping has traditionally relied on RNA-sequencing, this method is clinically impractical due to cost and often lacking direct sensitivity correlation. Therefore, we aim to develop an immunohistochemistry-based classification system for the major bladder cancer subtypes.</div></div><div><h3>Methods and Patient Summary</h3><div>We used the log10 IHC ratios of 3 markers to classify major bladder cancer subtypes.</div><div>We applied this subtyping in 3 patient cohorts. First on a tissue microarray cohort (<em>n</em> = 53) from cystectomy treated MIBC patients. Furthermore, a cisplatin-based neoadjuvant chemotherapy cohort with pre- and post-treatment tissues (<em>n</em> = 18). Finally, patient derived bladder cancer organoid cohort (<em>n</em> = 8) for direct subtype specific drug sensitivity testing.</div></div><div><h3>Key Findings and Limitations</h3><div>Our findings reveal that the classification system offers a valuable approach for subtyping patients individually, in cohorts and in patient-derived organoids (<em>n</em> = 8 distinct organoid lines). Second, this classification system allows detection of subtype changing in patients undergoing neoadjuvant chemotherapy. Furthermore, the classification system effectively distinguishes between significantly (<em>P</em> = 4.07e−10) cisplatin-sensitive (basal-like) and cisplatin-resistant (luminal-like) subtypes in bladder cancer organoids and is hypothesis generating.</div></div><div><h3>Conclusions and Clinical Implications</h3><div>Our findings suggest that our 3-marker classification system could be valuable as method in future BC patient subtyping for clinical stratification of patients undergoing cisplatin-based treatment.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"44 1","pages":"Pages 64.e15-64.e25"},"PeriodicalIF":2.3,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145393349","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}